Can Chagas disease cause acute cardiomyopathy?

From the Guidelines

Yes, Chagas disease can cause acute cardiomyopathy, although it is a rare occurrence during the acute phase of the disease 1.

Clinical Phases of Chagas Disease

The disease has three distinct clinical phases:

• Acute phase: characterized by mild illness, low case-fatality rate, and systemic spread of the parasites, which can lead to severe myocarditis in a small proportion of symptomatic patients.
• Indeterminate phase: asymptomatic, with lifelong low-grade parasitemias and subtle signs of cardiac or gastrointestinal involvement.
• Chronic phase: symptomatic, with cardiac involvement, including biventricular enlargement, thinning of ventricular walls, apical aneurysms, and mural thrombi, leading to cardiomyopathy and potentially life-threatening arrhythmias.

Pathogenesis and Treatment

The leading hypothesis for the pathogenesis of Chagas cardiomyopathy is progressive myocardial damage caused by parasite persistence and autoimmune responses 1. Treatment for Chagas disease is unsatisfactory, with benznidazole and nifurtimox being the only available options, which can shorten the acute phase and decrease mortality but achieve parasitologic cures in only about 50% of treated patients 1.

Cardiac Involvement

Cardiac involvement in Chagas disease can lead to conduction defects, life-threatening ventricular arrhythmias, and poor survival 1. Device therapy, including implantable cardioverter-defibrillators (ICDs), is frequently used in the late phase of the disease. Amiodarone appears to be effective in treating ventricular tachyarrhythmias, but VT recurrence rates are high, especially in patients with advanced heart failure.

From the Research

Chagas Disease and Acute Cardiomyopathy

• Chagas disease, caused by the protozoan Trypanosoma cruzi, can lead to acute cardiomyopathy, although it is a rare occurrence 2.
• The acute phase of Chagas disease is characterized by myocarditis, which can be severe and fulminant in some cases, leading to diffuse myocardial damage and death 2.
• Studies have shown that the risk of developing chronic cardiomyopathy is higher in patients with the acute phase of Chagas disease, with a pooled estimated annual rate of 4.6% 3.
• The pathogenesis of acute chagasic myocarditis is thought to be related to autoimmune mechanisms, with the presence of antibodies directed against different components of T. cruzi and cross-reacting with human antigens 2, 4.

Clinical Manifestations

• The clinical manifestations of acute Chagas disease include fever, muscular pain, sweating, swollen lymph nodes, and hepatospienomegaly 2, 4.
• In some cases, acute chagasic myocarditis can lead to severe cardiac dysfunction, including heart failure and arrhythmias 4, 5.
• The diagnosis of Chagas disease is based on a triad of positive epidemiology, positive serology, and a combination of clinical findings, including suggestive electrocardiographic abnormalities and cardiac enlargement 2.

Risk of Chronic Cardiomyopathy

• Patients with the indeterminate chronic form of Chagas disease have a significant annual risk of developing cardiomyopathy, with a pooled estimated annual rate of 1.9% 3.
• The risk of developing chronic cardiomyopathy is higher in patients with the acute phase of Chagas disease, with an annual risk more than double that of patients with the indeterminate chronic form 3.
• The development of chronic cardiomyopathy in patients with Chagas disease can lead to substantial morbidity and mortality, emphasizing the need for early diagnosis and treatment 5, 3.