Chronic Chagas’ Heart Disease in the Elderly: A Clinicopathologic Study

Abstract

A retrospective study of the medical records of our hospital from 1965 to 1985 was carried out to characterize for the first time chronic Chagas’ heart disease in the elderly (more than 70 years old). A total of 25 patients (mean age = 76) were suitable for the study. Congestive heart failure, sudden cardiac death, thromboembolism and atypical chest pain were found in 68, 16, 8 and 8% of cases, respectively. Ventricular premature contractions (60%), right bundle branch block (32%), left anterior hemiblock (28%), atrial fibrillation (28%) and right bundle branch block associated with left anterior hemiblock (20%) were the ECG changes most frequently found. A morphological study was performed on 8 (32%) patients. All of them showed cardiac abnormalities, with apical aneurism being detected in 100% of cases. At autopsy, pulmonary embolism was observed in 3 (37%) of these patients who presented with congestive heart failure, ventricular premature contractions and/or intraventricular conduction defect and/or atrial fibrillation. Thus, the characteristics of chronic Chagas’ heart disease in the elderly are similar to those found in middle-aged patients. We suggest that these patients are important for the study of the pathogenesis of chronic Chagas’ heart disease because they may have less aggressive pathophysiologic mechanisms than middle-aged patients.

The treatment of chronic heart failure secondary to Chagas cardiomyopathy in the contemporary era

“…16 Autopsy studies have revealed that pulmonary embolism may be found in up to 37% of patients who died of CHF secondary to Chagas cardiomyopathy. 20 Intractable pump failure appears to be the most important cause of death in patients with Chagas disease heart failure, mainly in those with advanced forms of the disease, 21 affecting up to 43% of patients with this condition.…”

Vagal impairment in elderly Chagas disease patients: A population-based study (The Bambuí Study)

“…Because there is no undisputable effective treatment for chronic infection, despite the effectiveness of the control measures, the disease might remain a public health problem for some decades among older subjects, through the operation of a cohort effect [4]. The effect of T. cruzi infection on the elderly has hardly been studied [4][5][6][7][8][9] and deserves more attention from the scientific community and from policy makers. Impairment of cardiac vagal modulation has been consistently reported in ChD [10][11][12][13] and may be related to both autoimmune and inflammatory mechanisms [14,15].…”

Noninvasive Predictors of Mortality for Patients with Chagas’ Heart Disease: A Multivariate Stepwise Logistic Regression Study

“…Chagas' heart disease is estimated to affect 10 million people in South America [1], The clinical manifestations of Chagas' heart dis ease are congestive heart failure, sudden car diac death, thromboembolic phenomena, atypical chest pain and arrhythmias [2][3][4],…”