Chagas disease natural history
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Natural history
Complications
In the chronic stage, treatment involves managing the clinical manifestations of the disease. For example, pacemakers and medications for irregular heartbeats, such as the anti-arrhythmia drug amiodarone, may be life saving for some patients with chronic cardiac disease,[1] while surgery may be required for megaintestine. The disease cannot be cured in this phase, however. Chronic heart disease caused by Chagas disease is now a common reason for heart transplantation surgery. Until recently, however, Chagas disease was considered a contraindication for the procedure, since the heart damage could recur as the parasite was expected to seize the opportunity provided by the immunosuppression that follows surgery.[2]
It was noted that survival rates in Chagas patients could be significantly improved by using lower dosages of the immunosuppressant drug ciclosporin. Recently, direct stem cell therapy of the heart muscle using bone marrow cell transplantation has been shown to dramatically reduce risks of heart failure in Chagas patients.[3]
Prognosis
An index for classification of patients who have Chagas' disease was published in the August 24, 2006 edition of the New England Journal of Medicine.[4] Based on over 500 patients, this index includes clinical aspects, X-ray findings, EKG, echocardiography and Holter.
| Risk factor | points |
|---|---|
| NYHA class III or IV | 5 |
| Cardiomegaly | 5 |
| Wall motion abnormalities | 3 |
| non-sustained ventricular tachycardia | 3 |
| low voltage on ECG | 2 |
| male sex | 2 |
| Total points | Risk of death in 10 years |
|---|---|
| 0–6 | 10% |
| 7–11 | 40% |
| 12–20 | 85% |
References
- ↑ Dubner S, Schapachnik E, Riera AR, Valero E (2008). "Chagas disease: state-of-the-art of diagnosis and management". Cardiol J. 15 (6): 493–504. PMID 19039752.
- ↑ Bocchi EA, Bellotti G, Mocelin AO (1996). "Heart transplantation for chronic Chagas' heart disease". Ann Thorac Surg. 61 (6): 1727–33. doi:10.1016/0003-4975(96)00141-5. PMID 8651775. Unknown parameter
|month=ignored (help) - ↑ Vilas-Boas F, Feitosa GS, Soares MB (2006). "Early results of bone marrow cell transplantation to the myocardium of patients with heart failure due to Chagas disease". Arq Bras Cardiol (in Portuguese). 87 (2): 159–66. doi:10.1590/S0066-782X2006001500014. PMID 16951834. Unknown parameter
|trans_title=ignored (help); Unknown parameter|month=ignored (help) - ↑ Rassi A Jr, Rassi A, Little W, Xavier S, Rassi S, Rassi A, Rassi G, Hasslocher-Moreno A, Sousa A, Scanavacca M (2006). "Development and validation of a risk score for predicting death in Chagas' heart disease". N Engl J Med. 355 (8): 799–808. PMID 16928995.