Chagas Disease Cardiomyopathy
| Autor: | José Antonio Marin-Neto, André Schmidt, Káryta Suely Macedo Martins, Minna Moreira Dias Romano, Marcus Vinicius Simões |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Chagas Cardiomyopathy
medicine.medical_specialty Myocarditis Insuficiência Cardíaca Inflammation Signs and symptoms Disease 030204 cardiovascular system & hematology Sudden death Doença de Chagas 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Chagas Disease 030212 general & internal medicine Chronic Chagas' Disease Cardiomyopathy Immune mechanisms Trypanosoma Cruzi Heart Failure business.industry Cardiomiopatias medicine.disease Cardiomiopatia Chagásica Heart failure Cardiology medicine.symptom business Cardiomyopathies |
| Zdroj: | International Journal of Cardiovascular Sciences, Volume: 31, Issue: 2, Pages: 173-189, Published: APR 2018 International Journal of Cardiovascular Sciences v.31 n.2 2018 International Journal of Cardiovascular Sciences Sociedade Brasileira de Cardiologia (SBC) instacron:SBC |
| Popis: | Chronic Chagas disease cardiomyopathy (CCC) is a result of low-intensity, but incessant, focal fibrosing myocarditis, caused by persistent T. cruzi infection associated with inflammation, mediated by adverse immune mechanisms. About 30 percent of infected individuals have developed throughout life the chronic cardiac form of Chagas' disease with protean clinical manifestations, such as sudden death, signs and symptoms of heart failure, cardioembolic events, arrhythmia and angioid symptoms. Sudden death and the progression of heart failure (HF) are the most common mechanisms of death in this condition. The most relevant prognostic aspects are symptoms of advanced HF (NYHA Fc III-IV), cardiomegaly, LV systolic dysfunction and nonsustained ventricular tachycardia. Preventing cardioembolic events is an important aspect in the management of patients with CCC. Oral anticoagulant agents must be prescribed for high-risk patients according to the presence of a set of risk factors: LV systolic dysfunction, apical aneurysm, altered ventricular repolarization by ECG and advanced age. The treatment of HF in patients with CCC follows the same principles applied to HF secondary to dilated cardiomyopathy of other etiologies. Resumo A cardiomiopatia crônica da doença de Chagas (CCDC) é resultante de miocardite fibrosante focal de baixa intensidade, mas incessante, causada pela infecção persistente do T cruzi, associada à inflamação mediada por mecanismos imunes adversos. Cerca de 30% dos infectados desenvolvem, ao longo da vida, a forma crônica cardíaca da doença de Chagas com manifestação clínica proteiforme, que pode incluir morte súbita, sintomas e sinais de insuficiência cardíaca, eventos cardioembólicos, arritmia e sintomas anginoides. A morte súbita e a progressão da insuficiência cardíaca (IC) são os mecanismos mais comuns de óbito nesta condição. Os aspectos prognósticos mais relevantes são sintomas de IC avançada (CF III/IV da NYHA), cardiomegalia, disfunção sistólica do VE e taquicardia ventricular não sustentada. A prevenção dos eventos cardioembólicos é aspecto importante no manejo dos pacientes com CCDC. Agentes anticoagulantes orais devem ser indicados para pacientes com risco elevado, conforme a presença de um conjunto de fatores de risco: disfunção sistólica do VE, aneurisma apical, alteração da repolarização ventricular ao ECG e idade avançada. O tratamento da IC na CCDC segue os mesmos princípios aplicados à IC secundária à cardiomiopatia dilatada de outras etiologias. |
| Databáze: | OpenAIRE |
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