From the Guidelines
Parasitic infections can indeed affect the cardiovascular system, with Chagas disease being a leading cause of death in many areas of Central and South America, resulting in approximately 50,000 deaths annually. Several parasitic organisms can directly invade cardiac tissue or cause inflammatory responses that damage the heart. Chagas disease, caused by Trypanosoma cruzi, is the most common parasitic heart disease worldwide, particularly in Latin America, and can lead to chronic heart failure, arrhythmias, and cardiac enlargement 1. Other parasites that can affect the heart include Toxoplasma gondii, which may cause myocarditis, particularly in immunocompromised individuals; Echinococcus, which can form hydatid cysts in the heart; and Schistosomiasis, which can cause pulmonary hypertension and right heart failure.
The mechanism of heart damage varies by parasite but often involves:
- Direct tissue invasion
- Inflammatory responses
- Autoimmune reactions
- Mechanical obstruction of blood flow Treatment depends on the specific parasite and may include antiparasitic medications such as benznidazole or nifurtimox for Chagas disease, albendazole for echinococcosis, and praziquantel for schistosomiasis 1. Early diagnosis and treatment are crucial as cardiac damage from parasitic infections can be irreversible. According to the European Society of Cardiology, an implantable cardioverter-defibrillator (ICD) should be considered in patients with Chagas cardiomyopathy and an left ventricular ejection fraction (LVEF) <40% when they are expected to survive >1 year with good functional status 1.
Key points to consider:
- Chagas disease is a significant cause of cardiovascular morbidity and mortality worldwide
- Early diagnosis and treatment are essential to prevent irreversible cardiac damage
- Antiparasitic medications and ICDs may be used to manage parasitic heart disease
- The mechanism of heart damage varies by parasite, but often involves direct tissue invasion, inflammatory responses, autoimmune reactions, or mechanical obstruction of blood flow 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Parasitic Infections and the Cardiovascular System
- Parasitic infections can affect the cardiovascular system, leading to various cardiac manifestations, including myocarditis, pericarditis, and cardiomyopathy 2, 3.
- Chagas disease, caused by Trypanosoma cruzi, is a major cause of dilated cardiomyopathy in the Americas and can lead to severe cardiac complications, including heart failure 4, 5.
- Antiparasitic treatment, such as benznidazole, can help prevent cardiac complications and improve clinical outcomes in patients with Chagas disease, especially when treated early 4, 5.
- Other parasitic infections, such as African trypanosomiasis, toxoplasmosis, and schistosomiasis, can also affect the cardiovascular system, leading to conditions like pulmonary hypertension and cor pulmonale 2, 3.
- The involvement of the heart in parasitic infections can be direct or indirect, and clinicians should consider parasitic infections in the differential diagnosis of myocardial and pericardial disease, especially in patients with unknown etiology 2, 3.
Treatment and Prevention
- Benznidazole is the primary treatment for Chagas disease, and its efficacy and tolerance are inversely related to the age of the patient 6.
- Low-dose benznidazole treatment has been shown to be effective in clearing parasites and reducing heart inflammatory reactions in experimental models of Chagas disease 4.
- Early treatment with antitrypanosomal therapy can prevent cardiac complications and improve clinical outcomes in patients with Chagas disease 5.
- Prevention of parasitic infections, such as through vector control and screening of blood donations, is also crucial in reducing the burden of cardiovascular disease caused by these infections 2.