Alexandre Aby Azar Ribeiro
Chagasic cardiomyopathy (CC) is a result of low intensity, but incessant, focal fibrosing myocarditis caused by persistent T. cruzi infection, associated with inflammation mediated by adverse immune mechanisms. About 30% of those infected develop chronic Chagas disease with multiple clinical manifestations, including sudden death, signs and symptoms of congestive heart failure, cardioembolic events, arrhythmias, and angina. Sudden death and progression of heart failure (HF) are the most common death mechanisms in this condition. The most relevant prognostic aspects are symptoms of advanced HF (NYHA CF III/IV), cardiomegaly, left ventricular systolic dysfunction and unsustained ventricular tachycardia. The prevention of cardioembolic events is an important aspect in the management of patients with CC.
Oral anticoagulant agents should be indicated for patients at high risk, according to the presence of a group of risk factors: Presence of apical aneurysm, HF, cardiac arrhythmia and female. The treatment of HF in chagasic cardiomyopathy follows the same principles applied to HF secondary to dilated cardiomyopathy of other etiologies.
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