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Jimenez A, Winokur EJ. Chagas Disease Cardiomyopathy. Dimens Crit Care Nurs 2023; 42:202-210. [PMID: 37219474 DOI: 10.1097/dcc.0000000000000590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
Chagas disease is a prominent neglected tropical disease endemic to many countries in Latin America. Cardiomyopathy is the most serious manifestation due to the severity and complications of heart failure. As a result of expanded immigration and globalization, there is an increased number of patients with Chagas cardiomyopathy who are being admitted to hospitals in the United States. It is imperative as a critical care nurse to be educated on the nature of Chagas cardiomyopathy as it differs from the more commonly seen ischemic and nonischemic forms. This article provides an overview of the clinical course, management, and treatment options of Chagas cardiomyopathy.
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Santos-Miranda A, Costa AD, Joviano-Santos JV, Rhana P, Bruno AS, Rocha P, Cau SB, Vieira LQ, Cruz JS, Roman-Campos D. Inhibition of calcium/calmodulin (Ca 2+ /CaM)-Calcium/calmodulin-dependent protein kinase II (CaMKII) axis reduces in vitro and ex vivo arrhythmias in experimental Chagas disease. FASEB J 2021; 35:e21901. [PMID: 34569665 DOI: 10.1096/fj.202101060r] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 11/11/2022]
Abstract
Chagasic cardiomyopathy (CCC) is one of the main causes of heart failure and sudden death in Latin America. To date, there is no available medication to prevent or reverse the onset of cardiac symptoms. CCC occurs in a scenario of disrupted calcium dynamics and enhanced oxidative stress, which combined, may favor the hyper activation of calcium/calmodulin (Ca2+ /CaM)-calcium/calmodulin-dependent protein kinase II (CaMKII) (Ca2+ /CaM-CaMKII) pathway, which is fundamental for heart physiology and it is implicated in other cardiac diseases. Here, we evaluated the association between Ca2+ /CaM-CaMKII in the electro-mechanical (dys)function of the heart in the early stage of chronic experimental Trypanosoma cruzi infection. We observed that in vitro and ex vivo inhibition of Ca2+ /CaM-CaMKII reversed the arrhythmic profile of isolated hearts and isolated left-ventricles cardiomyocytes. The benefits of the limited Ca2+ /CaM-CaMKII activation to cardiomyocytes' electrical properties are partially related to the restoration of Ca2+ dynamics in a damaged cellular environment created after T. cruzi infection. Moreover, Ca2+ /CaM-CaMKII inhibition prevented the onset of arrhythmic contractions on isolated heart preparations of chagasic mice and restored the responsiveness to the increase in the left-ventricle pre-load. Taken together, our data provide the first experimental evidence for the potential of targeting Ca2+ /CaM-CaMKII pathway as a novel therapeutic target to treat CCC.
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Affiliation(s)
| | - Alexandre D Costa
- Department of Physiology and Biophysics, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Paula Rhana
- Department of Biochemistry and Immunology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Alexandre Santos Bruno
- Department of Pharmacology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Peter Rocha
- Department of Biochemistry and Immunology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Stefany Bruno Cau
- Department of Pharmacology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Leda Q Vieira
- Department of Biochemistry and Immunology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Jader S Cruz
- Department of Biochemistry and Immunology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Danilo Roman-Campos
- Department of Biophysics, Universidade Federal de São Paulo, São Paulo, Brazil
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Abstract
American trypanosomiasis is caused by a parasite endemic of the Americas. Current migration has globalized Chagas disease. Acute infection usually resolves spontaneously. Nonetheless, 20% to 40% develop cardiomyopathy 20 to 30 years later. Progression to cardiomyopathy is devastatingly rapid, manifesting with heart failure and sudden death. Etiologic treatment is highly effective and recommended in those with acute infections, congenital infections, and parasite reactivation, and women of childbearing age, but in asymptomatic Trypanosoma cruzi carriers and patients with early cardiomyopathy remains controversial and under investigation. Progression of heart failure is rapid and accounts for most of the morbidity and related mortality.
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Affiliation(s)
- Luis E Echeverria
- Grupo de Estudios Epidemiológicos y Salud Pública, Heart Failure and Heart Transplant Clinic, Fundacion Cardiovascular de Colombia, Calle 155 A No. 23-58, Urbanizacion El Bosque, Floridablanca, Santander, Colombia
| | - Carlos A Morillo
- Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Foothills Medical Centre, Room C823, 1403 29th Street Northwest, Calgary, Alberta T2N 2T9, Canada.
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Nunes MCP, Beaton A, Acquatella H, Bern C, Bolger AF, Echeverría LE, Dutra WO, Gascon J, Morillo CA, Oliveira-Filho J, Ribeiro ALP, Marin-Neto JA. Chagas Cardiomyopathy: An Update of Current Clinical Knowledge and Management: A Scientific Statement From the American Heart Association. Circulation 2018; 138:e169-e209. [DOI: 10.1161/cir.0000000000000599] [Citation(s) in RCA: 201] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background:
Chagas disease, resulting from the protozoan
Trypanosoma cruzi
, is an important cause of heart failure, stroke, arrhythmia, and sudden death. Traditionally regarded as a tropical disease found only in Central America and South America, Chagas disease now affects at least 300 000 residents of the United States and is growing in prevalence in other traditionally nonendemic areas. Healthcare providers and health systems outside of Latin America need to be equipped to recognize, diagnose, and treat Chagas disease and to prevent further disease transmission.
Methods and Results:
The American Heart Association and the Inter-American Society of Cardiology commissioned this statement to increase global awareness among providers who may encounter patients with Chagas disease outside of traditionally endemic environments. In this document, we summarize the most updated information on diagnosis, screening, and treatment of
T cruzi
infection, focusing primarily on its cardiovascular aspects. This document also provides quick reference tables, highlighting salient considerations for a patient with suspected or confirmed Chagas disease.
Conclusions:
This statement provides a broad summary of current knowledge and practice in the diagnosis and management of Chagas cardiomyopathy. It is our intent that this document will serve to increase the recognition of Chagas cardiomyopathy in low-prevalence areas and to improve care for patients with Chagas heart disease around the world.
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CARDOSO RHANDERSON, GARCIA DANIEL, FERNANDES GILSON, HE LI, LICHTENBERGER PAOLA, VILES-GONZALEZ JUAN, COFFEY JAMESO, MITRANI RAULD. The Prevalence of Atrial Fibrillation and Conduction Abnormalities in Chagas’ Disease: A Meta-Analysis. J Cardiovasc Electrophysiol 2015; 27:161-9. [DOI: 10.1111/jce.12845] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 09/14/2015] [Accepted: 09/18/2015] [Indexed: 12/15/2022]
Affiliation(s)
- RHANDERSON CARDOSO
- Division of Cardiology, Department of Internal Medicine, Jackson Memorial Hospital; University of Miami; Miami Florida USA
| | - DANIEL GARCIA
- Division of Cardiology, Department of Internal Medicine, Jackson Memorial Hospital; University of Miami; Miami Florida USA
| | - GILSON FERNANDES
- Division of Cardiology, Department of Internal Medicine, Jackson Memorial Hospital; University of Miami; Miami Florida USA
| | - LI HE
- Division of Cardiology, Department of Internal Medicine, Jackson Memorial Hospital; University of Miami; Miami Florida USA
| | - PAOLA LICHTENBERGER
- Division of Cardiology, Department of Internal Medicine, Jackson Memorial Hospital; University of Miami; Miami Florida USA
| | - JUAN VILES-GONZALEZ
- Division of Cardiology, Department of Internal Medicine, Jackson Memorial Hospital; University of Miami; Miami Florida USA
| | - JAMES O. COFFEY
- Division of Cardiology, Department of Internal Medicine, Jackson Memorial Hospital; University of Miami; Miami Florida USA
| | - RAUL D. MITRANI
- Division of Cardiology, Department of Internal Medicine, Jackson Memorial Hospital; University of Miami; Miami Florida USA
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Enriquez A, Conde D, Femenia F, de Luna AB, Ribeiro A, Muratore C, Valentino M, Retyk E, Galizio N, Hopman WM, Baranchuk A. Relation of interatrial block to new-onset atrial fibrillation in patients with Chagas cardiomyopathy and implantable cardioverter-defibrillators. Am J Cardiol 2014; 113:1740-3. [PMID: 24698463 DOI: 10.1016/j.amjcard.2014.02.036] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 02/21/2014] [Accepted: 02/21/2014] [Indexed: 01/05/2023]
Abstract
Chagas cardiomyopathy is an endemic disease in Latin America. A significant proportion of patients develop atrial fibrillation (AF), which may result in stroke and increased morbidity or mortality. Interatrial block (IAB) has been associated with the development of AF in different clinical scenarios. The aim of our study was to determine whether IAB can predict new-onset AF in patients with Chagas cardiomyopathy and implantable cardioverter-defibrillators (ICDs). We conducted a retrospective study of patients with Chagas cardiomyopathy and ICDs from 14 centers in Latin America. Demographics, clinical, and device follow-up were collected. Surface electrocardiograms were scanned at 300 dpi and maximized ×8. Semiautomatic calipers were used to determine P-wave onset and offset. Partial IAB was defined as a P wave of >120 ms and advanced IAB as a P wave of >120 ms with biphasic morphology (±) in inferior leads. AF events and ICD therapies were reviewed during follow-up by 2 independent investigators. A total of 80 patients were analyzed. Mean age was 54.6 ± 10.4 years, and 52 (65%) were male. Mean left ventricular ejection fraction was 40 ± 12%. IAB was detected in 15 patients (18.8%), with 8 (10.0%) partial and 7 (8.8%) advanced. During a follow-up of 33 ± 20 months, 11 patients (13.8%) presented with new AF. IAB (partial + advanced) was strongly associated with new AF (p <0.0001) and inappropriate therapy by the ICD (p = 0.014). In conclusion, IAB (partial + advanced) predicted new-onset AF in patients with Chagas cardiomyopathy and ICDs.
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Affiliation(s)
| | - Diego Conde
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | | | - Antoni Bayés de Luna
- Cardiovascular Research Center, CSIC-ICCC, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Antonio Ribeiro
- Universidade Federal de Minais Gerais, Belo Horizonte, Brazil
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Cortez J, Providência R, Ramos E, Valente C, Seixas J, Meruje M, Leitão-Marques A, Vieira A. Emerging and under-recognized Chagas cardiomyopathy in non-endemic countries. World J Cardiol 2012; 4:234-9. [PMID: 22905296 PMCID: PMC3421137 DOI: 10.4330/wjc.v4.i7.234] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2012] [Revised: 05/15/2012] [Accepted: 05/22/2012] [Indexed: 02/06/2023] Open
Abstract
Due to recent population emigration movements, an epidemic of Chagas disease is currently menacing most developed countries. The authors report the case of a 53-year-old Brazilian woman living in Europe for the last 10 years who developed heart failure symptoms, having a previous symptomatic sinus node disease with a pacemaker implant at age of 40 years. The diagnosis was based on serology and myocardial biopsy and the patient was treated with nifurtimox. The authors emphasize the need of a high level of suspicion in patients with suggestive epidemiology and the need of populational screening of specific high risk groups. New treatment options are also discussed.
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Affiliation(s)
- Joana Cortez
- Joana Cortez, Evelise Ramos, Cristina Valente, António Vieira, Infectious Diseases Department, Coimbra's Hospital Centre and University, 3041-801 Coimbra, Portugal
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Abstract
A hundred years from its description, Chagas cardiomyopathy remains a challenging disease. Although successful vector-control strategies have decreased the incidence of Chagas disease in several Latin American countries, both migration to urban areas and immigration have spread the disease worldwide; and now, blood transfusion, organ transplantation, and vertical transmission are a concern. The pathogenesis of Chagas cardiomyopathy involves complex host-parasite interactions, where low-grade but incessant systemic infection and triggered autoimmune reaction are the main mechanisms for its development, with the contribution of autonomic damage and microvascular disturbances. Chagas cardiomyopathy is the most important clinical presentation of Chagas disease and comprises a wide range of manifestations, including heart failure, arrhythmias, heart blocks, sudden death, thromboembolism, and stroke. Recently, simple clinical prognostic scores have been developed to identify high-risk patients and help with management. The treatment of Chagas cardiomyopathy focuses mostly on managing heart failure, arrhythmias, and thromboembolism. The role of specific antiparasitic therapy in the chronic form is not yet defined, and a randomized trial is now under way to address this crucial point. In this article, we review the main clinical aspects of Chagas cardiomyopathy and underscore some upcoming challenges for the appropriate control, diagnosis, and management of this complex disease.
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Affiliation(s)
- Andréia Biolo
- Division of Cardiology, Hospital de Clínicas de Porto Alegre and Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
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Predictors of mortality in Chagas' disease: The impact of atrial fibrillation and oral transmission on infected population. Int J Cardiol 2009; 133:275-7. [DOI: 10.1016/j.ijcard.2007.11.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2007] [Accepted: 11/12/2007] [Indexed: 11/18/2022]
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Benchimol-Barbosa P, Barbosa-Filho J. Mechanical cardiac remodeling and new-onset atrial fibrillation in long-term follow-up of subjects with chronic Chagas' disease. Braz J Med Biol Res 2009; 42:251-62. [DOI: 10.1590/s0100-879x2009000300006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Accepted: 01/07/2009] [Indexed: 11/21/2022] Open
Affiliation(s)
- P.R. Benchimol-Barbosa
- Universidade do Estado do Rio de Janeiro, Brasil; Corpo de Bombeiros Militar do Estado do Rio de Janeiro, Brasil; Universidade Gama Filho, Brasil
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Benchimol-Barbosa PR. Cardiac remodeling and predictors for cardiac death in long-term follow-up of subjects with chronic Chagas' heart disease: A mathematical model for progression of myocardial damage. Int J Cardiol 2009; 131:435-8. [DOI: 10.1016/j.ijcard.2007.07.151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2007] [Accepted: 07/07/2007] [Indexed: 11/27/2022]
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