The Valsalva maneuver in Chagas disease patients without cardiopathy

Ribeiro, Antônio Luiz Pinho; Campos, Marcos Soares; Baptista, Leonardo Matos Gomes; Sousa, Marcos Roberto de

doi:10.1007/s10286-009-0044-z

Cited by 7 publications

(5 citation statements)

References 23 publications

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“…Normal autonomic modulation of the heart is also encountered in chagasics with any form of the disease. When present, the disturbance occurs with variable severity according to the chronic form of the disease and even between subjects affected with the same form 8,9,17,[30][31][32][33][34][35][36][37] . Chronically infected children with the indeterminate form also show cardiac autonomic dysfunction 38 .…”

Section: Cardiac Autonomic Nervous System In Chagas Diseasementioning

confidence: 99%

“…The inability to achieve adequate tachycardia and blood pressure stabilisation upon standing has also been demonstrated [74][75][76] . Depressed sensitivity of the baroreflex mechanism resulting in blunted bradycardia or tachycardia in response to acute elevation or reduction of arterial pressure has been observed 32,77 , as have altered baroreflex responses traduced by deficient heart rate responses during and after the Valsalva manoeuvre in chagasics with any form of the disease 8,33,36,78,79 . Additionally, moment-to-moment heart rate variability is variably depressed in chagasic subjects both in supine and standing positions 9,10,39,41,46,68,80 .…”

Section: Disturbed Cardiovascular Homeostatic Neural Regulationmentioning

confidence: 99%

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Insights into the clinical and functional significance of cardiac autonomic dysfunction in Chagas disease

Junqueira Junior

2012

Rev. Soc. Bras. Med. Trop.

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INTRODUCTION: Exclusive or associated lesions in various structures of the autonomic nervous system occur in the chronic forms of Chagas disease. In the indeterminate form, the lesions are absent or mild, whereas in the exclusive or combined heart and digestive disease forms, they are often more pronounced. Depending on their severity these lesions can result mainly in cardiac parasympathetic dysfunction but also in sympathetic dysfunction of variable degrees. Despite the key autonomic effect on cardiovascular functioning, the pathophysiological and clinical significance of the cardiac autonomic dysfunction in Chagas disease remains unknown. METHODS: Review of data on the cardiac autonomic dysfunction in Chagas disease and their potential consequences, and considerations supporting the possible relationship between this disturbance and general or cardiovascular clinical and functional adverse outcomes. RESULTS: We hypothesise that possible consequences that cardiac dysautonomia might variably occasion or predispose in Chagas disease include: transient or sustained arrhythmias, sudden cardiac death, adverse overall and cardiovascular prognosis with enhanced morbidity and mortality, an inability of the cardiovascular system to adjust to functional demands and/or respond to internal or external stimuli by adjusting heart rate and other hemodynamic variables, and immunomodulatory and cognitive disturbances. CONCLUSIONS: Impaired cardiac autonomic modulation in Chagas disease might not be a mere epiphenomenon without significance. Indirect evidences point for a likely important role of this alteration as a primary predisposing or triggering cause or mediator favouring the development of subtle or evident secondary cardiovascular functional disturbances and clinical consequences, and influencing adverse outcomes.

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Section: Cardiac Autonomic Nervous System In Chagas Diseasementioning

confidence: 99%

Section: Disturbed Cardiovascular Homeostatic Neural Regulationmentioning

confidence: 99%

Insights into the clinical and functional significance of cardiac autonomic dysfunction in Chagas disease

Junqueira Junior

2012

Rev. Soc. Bras. Med. Trop.

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“…Patients with Chagas disease, for example, are known to have lower Valsalva ratios than healthy controls, but a recent metaanalysis found the average Valsalva ratio among Chagas patients to be 1.74, which is well within the limits of normal. 3,33 Likewise, previous studies have demonstrated differences between PLR parameters of healthy and diabetic subjects, and PLR abnormalities can be found among patients with diabetes with and without abnormalities on CAT. 14,15,[34][35][36] Abnormal PLRs have been associated with future microvascular disease and may be associated with future CAT abnormalities.…”

Section: Discussionmentioning

confidence: 89%

Pupillary Light Reflexes are Associated with Autonomic Dysfunction in Bolivian Diabetics But Not Chagas Disease Patients

Halperin

Pajuelo

Tornheim

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Abstract. Autonomic dysfunction is common in Chagas disease and diabetes. Patients with either condition complicated by cardiac autonomic dysfunction face increased mortality, but no clinical predictors of autonomic dysfunction exist. Pupillary light reflexes (PLRs) may identify such patients early, allowing for intensified treatment. To evaluate the significance of PLRs, adults were recruited from the outpatient endocrine, cardiology, and surgical clinics at a Bolivian teaching hospital. After testing for Chagas disease and diabetes, participants completed conventional autonomic testing (CAT) evaluating their cardiovascular responses to Valsalva, deep breathing, and orthostatic changes. PLRs were measured using specially designed goggles, then CAT and PLRs were compared as measures of autonomic dysfunction. This study analyzed 163 adults, including 96 with Chagas disease, 35 patients with diabetes, and 32 controls. PLRs were not significantly different between Chagas disease patients and controls. Patients with diabetes had longer latency to onset of pupil constriction, slower maximum constriction velocities, and smaller orthostatic ratios than nonpatients with diabetes. PLRs correlated poorly with CAT results. A PLR-based clinical risk score demonstrated a 2.27-fold increased likelihood of diabetes complicated by autonomic dysfunction compared with the combination of blood tests, CAT, and PLRs (sensitivity 87.9%, specificity 61.3%). PLRs represent a promising tool for evaluating subclinical neuropathy in patients with diabetes without symptomatic autonomic dysfunction. Pupillometry does not have a role in the evaluation of Chagas disease patients.

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“…Autonomic balance assessment using the Valsalva maneuver has been widely used in chagasic patients (21) (30) (31) and showed no difference between the groups examined in the present study. Similarly, a recent meta-analysis (32) demonstrated that only one of the seven studies analyzed found a signifi cant difference in the Valsalva ratio between healthy individuals and chagasic patients without cardiopathy. The authors also reported that in certain studies that did not detect any signifi cant difference, other autonomic indexes (such as respiratory sinus arrhythmia) were able to recognize reduced heart vagal modulation in ChD patients without cardiopathy.…”

Section: Autonomic Balance In Chagas Disease Patientsmentioning

confidence: 87%

Exercise-induced ventricular arrhythmias and vagal dysfunction in Chagas disease patients with no apparent cardiac involvement

Costa

Nunes

Souza

et al. 2015

Rev. Soc. Bras. Med. Trop.

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Introduction: Exercise-induced ventricular arrhythmia (EIVA) and autonomic imbalance are considered as early markers of heart disease in Chagas disease (ChD) patients. The objective of the present study was to verify the differences in the occurrence of EIVA and autonomic maneuver indexes between healthy individuals and ChD patients with no apparent cardiac involvement. Methods: A total of 75 ChD patients with no apparent cardiac involvement, aged 44.7 (8.5) years, and 38 healthy individuals, aged 44.0 (9.2) years, were evaluated using echocardiography, symptom-limited treadmill exercise testing and autonomic function tests. Results: The occurrence of EIVA was higher in the chagasic group (48%) than in the control group (23.7%) during both the effort and the recovery phases. Frequent ventricular contractions occurred only in the patient group. Additionally, the respiratory sinus arrhythmia index was signifi cantly lower in the chagasic individuals compared with the control group. Conclusions: ChD patients with no apparent cardiac involvement had a higher frequency of EIVA as well as more vagal dysfunction by respiratory sinus arrhythmia. These results suggest that even when asymptomatic, ChD patients possess important arrhythmogenic substrates and subclinical disease.

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The Valsalva maneuver in Chagas disease patients without cardiopathy

Abstract: ChD patients without cardiopathy have reduced VR values compared to healthy controls, indicating early vagal dysfunction. Most previous studies could not detect this impairment due to small study samples and insufficient statistical power.

Cited by 7 publications

References 23 publications

Insights into the clinical and functional significance of cardiac autonomic dysfunction in Chagas disease

Insights into the clinical and functional significance of cardiac autonomic dysfunction in Chagas disease

Pupillary Light Reflexes are Associated with Autonomic Dysfunction in Bolivian Diabetics But Not Chagas Disease Patients

Exercise-induced ventricular arrhythmias and vagal dysfunction in Chagas disease patients with no apparent cardiac involvement

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