Diagnosis and management of Chagas disease and cardiomyopathy

Ribeiro, Antônio Luiz Pinho; Nunes, Maurício Buzelin; Teixeira, Mauro Martins; Rocha, Manoel Otávio Costa

doi:10.1038/nrcardio.2012.109

Cited by 281 publications

(347 citation statements)

References 160 publications

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“…6 Furthermore, a variation of the proportion of normal ECGs was observed, ranging from 55.0 to 61.5%, depending on the mesoregion where the exam originated from. (Table 4).…”

Section: Resultsmentioning

confidence: 99%

Prevalence of normal electrocardiograms in primary care patients

Marcolino

Palhares

Alkmim

et al. 2014

Rev. Assoc. Med. Bras.

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Objective: Knowing the proportion the proportion of normal and abnormal electrocardiograms (ECGs) in primary care patients allows us to estimate the proportion of exams that can be analyzed by the general practitioner with minimal training in ECG interpretation, in addition to being epidemiologically relevant. The objective of this study is to assess the prevalence of normal ECGs in primary care patients. Methods: all digital ECGs analyzed by the cardiologists of Telehealth Network of Minas Gerais (TNMG) in 2011 were evaluated. TNMG is a public telehealth service that provides support to primary care professionals in 662 municipalities in the state of Minas Gerais, Brazil. Results: during the study period, 290,795 ECGs were analyzed (mean age 51 ± 19 years), 57.6% were normal. This proportion was higher in women (60.1 vs 57.6%, p <0.001) and lower in patients with hypertension (45.8% vs 63.2%, p <0.001) or diabetes (43.3% vs 63.2%, p <0.001). A progressive reduction in the prevalence of normal ECG with increasing age was observed. Among the ECGs of patients under investigation for chest pain, 58.7% showed no abnormalities. Conclusion: the prevalence of normal ECGs in primary care patients is higher than 50% and this proportion decreases with age and comorbidities. Most ECGs performed for investigation of chest pain in primary care shows no abnormality.Uniterms: electrocardiography, telemedicine, primary health care.

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“…6 Furthermore, a variation of the proportion of normal ECGs was observed, ranging from 55.0 to 61.5%, depending on the mesoregion where the exam originated from. (Table 4).…”

Section: Resultsmentioning

confidence: 99%

Prevalence of normal electrocardiograms in primary care patients

Marcolino

Palhares

Alkmim

et al. 2014

Rev. Assoc. Med. Bras.

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“…CHF management mirrors recommendations made for HF from other etiologies, despite that the majority of these interventions have not been specifically tested in patients with Chagas disease (9) (10) . In this context, CR programs have been extensively encouraged as an important coadjuvant in the treatment of HF, but studies evaluating the effects of CR on CHF remain scarce.…”

Section: Discussionmentioning

confidence: 99%

“…CHF treatment aims to manage symptoms, decrease mortality, and improve quality of life for the patient (9) . However, therapeutic approaches for CHF remain limited to the standard recommendations for HF treatment due to other conditions (10) ; therefore, studies evaluating the effects of CHF-specific strategies are necessary.…”

Section: Introductionmentioning

confidence: 99%

Cardiac rehabilitation program in patients with Chagas heart failure: a single-arm pilot study

Mediano

Mendes

Pinto

et al. 2016

Rev. Soc. Bras. Med. Trop.

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Introduction:The benefit of a cardiac rehabilitation (CR) program for patients with Chagas heart failure (CHF) remains unclear. Therefore, we aimed to investigate the effects of CR for CHF patients. Methods: A single-arm pilot study, including 12 patients with CHF, was performed. Patients participated in an 8-month physical exercise intervention, comprising aerobic, strength, and stretching exercises (3 times per week, 60 minutes per session). Nutritional and pharmaceutical counseling were also performed. Functional capacity (cardiopulmonary exercise test), muscle respiratory strength (manovacuometry), and body composition (anthropometry and skinfolds) were evaluated at baseline, and after 4 and 8 months of intervention. Cardiac function (echocardiography), biomarkers (lipid profile, glucose, and glycated hemoglobin) and quality of life (Minnesota Living with Heart Failure Questionnaire) were assessed at baseline and at the end of the intervention. Results: Seven of 12 patients included in the study completed the 8-month follow-up period. Only 2 moderate adverse events occurred during the exercise training. Functional capacity improved after 4 months of CR, while left ventricular ejection fraction (LVEF) and respiratory strength improved after 8 months. Patients with right ventricular (RV) dysfunction at baseline exhibited an improvement in functional capacity after 4 months, and improvements in left ventricular (LV) diastolic pressure, respiratory strength, and quality of life at the end of follow-up. Conversely, those with normal baseline RV function demonstrated LVEF increases that were not observed in patients with RV dysfunction. Conclusions: CR was feasible, safe, and has important clinical benefits for patients with CHF, specifically for cardiac function and muscle respiratory strength.

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“…It has substantial impacts on the economy and on morbidity and mortality (1), (2) . More recently, with increased migration, it has also become a problem for developed countries, which now have hundreds of thousands of patients with this disease 3 . The clinical course of the disease is extremely variable, and although many individuals remain asymptomatic for long periods, approximately one-third of infected patients develop life-threatening heart disease, including malignant ventricular arrhythmias (3), (4) .…”

Section: Introductionmentioning

confidence: 99%

“…Ventricular arrhythmias associated with Chagas heart disease (ChD) have high rates of morbidity and mortality (3) . In this narrative literature review, we discuss the main clinical and epidemiological aspects of ventricular arrhythmias in ChD, as well as specifi c workups and treatment.…”

Section: Introductionmentioning

confidence: 99%

Ventricular arrhythmias in Chagas disease

Barbosa

Carmo

Rocha

et al. 2015

Rev. Soc. Bras. Med. Trop.

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Sudden death is one of the most characteristic phenomena of Chagas disease, and approximately one-third of infected patients develop life-threatening heart disease, including malignant ventricular arrhythmias. Fibrotic lesions secondary to chronic cardiomyopathy produce arrhythmogenic substrates that lead to the appearance and maintenance of ventricular arrhythmias. The objective of this study is to discuss the main clinical and epidemiological aspects of ventricular arrhythmias in Chagas disease, the specifi c workups and treatments for these abnormalities, and the breakthroughs needed to determine a more effective approach to these arrhythmias. A literature review was performed via a search of the PubMed database from 1965 to May 31, 2014 for studies of patients with Chagas disease. Clinical management of patients with chronic Chagas disease begins with proper clinical stratifi cation and the identifi cation of individuals at a higher risk of sudden cardiac death. Once a patient develops malignant ventricular arrhythmia, the therapeutic approach aims to prevent the recurrence of arrhythmias and sudden cardiac death by the use of implantable cardioverter defi brillators, antiarrhythmic drugs, or both. In select cases, invasive ablation of the reentrant circuit causing tachycardia may be useful. Ventricular arrhythmias are important manifestations of Chagas cardiomyopathy. This review highlights the absence of high-quality evidence regarding the treatment of ventricular arrhythmias in Chagas disease. Recognizing high-risk patients who require specifi c therapies, especially invasive procedures such as the implantation of cardioverter defi brillators and ablative approaches, is a major challenge in clinical practice.

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Diagnosis and management of Chagas disease and cardiomyopathy

Cited by 281 publications

References 160 publications

Prevalence of normal electrocardiograms in primary care patients

Prevalence of normal electrocardiograms in primary care patients

Cardiac rehabilitation program in patients with Chagas heart failure: a single-arm pilot study

Ventricular arrhythmias in Chagas disease

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