Clinical and morphological characteristics associated with sudden cardiac death in patients with Chagas' disease

Abstract

The medical records of 24 patients with Chagas disease who died suddenly, between 1982 and 1988, were examined in an attempt to determine the clinical profile of sudden death in Chagas disease. Patient age ranged from 33 to 72 years (average: 51). Seventeen (70%) were male: Five (20%) were asymptomatic. Dyspnoea at rest was observed in 16 (66%) and palpitations in eight (33%). On physical examination, arrhythmias were observed in 14 (58%), ankle swelling in 13 (54%) and liver enlargement in 12 (50%) patients. Twenty-three (95%) patients had an abnormal resting electrocardiogram: ventricular premature contractions were observed in 19 patients (79%) and a left anterior fascicular block in 14 (58%). The chest X-ray revealed cardiomegaly in 20 patients (82%), which was moderate in three (13%) and severe in 11 (45%). At autopsy, mean heart weight was 496 g. Dilatation of all cardiac chambers was detected in 22 (91%), and apical aneurysm in 19 (79%) patients. When compared with symptomatic patients, asymptomatic patients with Chagas disease had a higher frequency of normal physical examination (3/5 vs 1/19, P < 0.004), normal chest X-ray (3/5 vs 1/19, P < 0.01), and a lower heart weight (400 +/- 43 g vs 521.58 +/- 146.26 g, P < 0.03). The majority of patients with Chagas disease who die suddenly have severe underlying myocardial disease. In some of them, however, sudden cardiac death may occur in the presence of minimal, if any, heart involvement.

Mechanical cardiac remodeling and new-onset atrial fibrillation in long-term follow-up of subjects with chronic Chagas' disease

“…It is particularly interesting to note that palpitations, a symptom commonly related to arrhythmia, have been considered to be a possible indication of adverse outcome in Chagas' disease (22), and conduction delay, on the other hand, reported in 5.8 to 20.2% of subjects with chronic Chagas' cardiomyopathy (23), has been regarded as a degenerative disturbance and a consequence of conduction system fibrosis (24).…”

Sudden death in Chagas' disease

“…Sudden death in the chagasic patient occurs mainly between 30 and 50 years of age, being rarer after the sixth decade of life, and predominates in males 13,33,34 . It usually happens during routine activities, physical exertion, or emotion, and is of the instantaneous type in around half of the cases.…”

Doppler tissue imaging to assess systolic function in Chagas' disease

“…Of the investigative methods, 12-lead electrocardiography has been extensively studied in Chagas' disease. Although the presence of a normal electrocardiogram is related to an excellent prognosis 5 , evidence of left ventricular contractile abnormalities 6,7 , diastolic dysfunction 8 , and even sudden death 9 exists in patients with Chagas' disease with no electrocardiographic abnormalities.…”