Introduction
Among parasite infections in the Western Hemisphere, Chagas disease (CD) is the most costly and harmful to health. Trypanosoma cruzi, or T. cruzi, is the protozoa that causes it and affects 6 to 7 million people globally. Migration patterns have led to the urbanization of the illness, which has then spread to other continents, even though it has often been restricted to endemic rural regions in Latin America.
Chronic parasitism, tissue inflammation caused by parasites, microvascular and neurogenic dysfunction, and infection-induced immunological reactions cause Chagas cardiomyopathy. The degree of myocardial injury determines the clinical presentation, which varies greatly and mostly presents as one of three primary syndromes: heart failure, cardiac arrhythmia, or thromboembolism, which can coexist in a single patient.
What Is Chagas Disease?
Trypanosoma cruzi, the parasite agent that causes Chagas disease, is often referred to as American trypanosomiasis. The majority of its dissemination is caused by "kissing bugs," or insects belonging to the Triatominae subfamily. As the illness worsens, the symptoms fluctuate. Headaches, fever, enlarged lymph nodes, and bite site edema are common early-stage symptoms that are usually either absent or very minor. In most situations, the chronic phase of the disease does not cause new symptoms after four to eight weeks if treatment is not received. Ten to thirty years after the original sickness, up to forty-five percent of those with chronic infections develop heart disease, which can result in heart failure. Up to 21 percent of patients may also encounter digestive issues, such as an enlarged colon or esophagus, and up to 10 percent may suffer nerve damage.
What Are the Mode of Transmission of Chagas Disease?
Vector-borne transmission is the primary mode of infection for individuals who are born in endemic regions. But with an increase in acute Chagas disease cases, food-borne transmission has recently been scrutinized in the Amazon region. In both endemic and non-endemic nations, there are potential additional pathways of transmission, such as organ transplantation, congenital conditions, and blood transfusion. While all of these transmission pathways may be reduced with appropriate control measures, patients who are already infected need the right treatment to extend their lives, avoid problems, and enhance their quality of life.
What Are the Cardiac Manifestations of Chagas Cardiomyopathy?
The three main symptoms associated with chronic Chagas disease are:
Thromboembolism - A significant factor in chronic Chagas' heart disease is thromboembolic events. A major consequence of the illness is pulmonary embolism and systemic embolism. Several of the disease's clinical manifestations should consider anticoagulant medication as a prophylactic measure against thromboembolic events.
Cardiac Arrhythmia - In endemic regions, bundle branch block and AV block are mostly caused by Chagas' disease. Increased sympathetic tone often exacerbates these arrhythmias, suggesting a higher risk of cardiac abrupt death in chagasic individuals, which can occasionally be the initial sign of the disease. In locations where the disease is endemic, chronic chagasic myocarditis is the primary cause of cardiovascular mortality, mostly as a result of heart failure and abrupt death.
Heart Failure - Over 80 percent of fatalities from cardiovascular disease (CVD) occur in low- and middle-income nations, making it the primary cause of early mortality globally. The underlying pathophysiology of Chagas disease is an immune-inflammatory response that primarily causes myocardial fibrosis and remodeling. These processes frequently lead to various forms of heart block, recurrent cardiac arrhythmias, dilated cardiomyopathy with HF (heart failure), and a decreased ejection fraction.
The degree of myocardial damage and the length of the disease both influence how the disease manifests clinically. The initial signs and symptoms of Chagas cardiomyopathy are often minor and are often identified by the absence of symptoms on the electrocardiogram (ECG) or in other supplementary tests, such as MRI, echocardiography, or 24-hour Holter monitoring. Advanced conduction problems, most often the combination of full right bundle branch block and left anterior fascicular block, and premature ventricular contractions are the subsequent signs. Ventricular arrhythmias and clinical deterioration are often predicted by the extent of myocardial injury. The latter phases of the illness are characterized by left ventricular enlargement and a decline in overall systolic function, which are common causes of all dilated cardiomyopathies.
What Are the Treatment Modalities That Are Used to Treat Cardiac Manifestations of Chagas Disease?
The following are the treatment modalities that are used to treat cardiac manifestations:
1. Non-Pharmacological Methods
Several lifestyle modification-based non-pharmacological methods, such as exercise-based cardiac rehabilitation (CR), pharmaceutical care, and dietary counseling, have shown promising results in the clinical management of patients with congestive heart failure (CHD). Guidelines for nutrition, self-care encouragement, treatment compliance, frequent exercise, and abstinence from alcohol and tobacco are all part of the first strategy. These tactics must be used in clinical practice since they are often simple to apply and require little upkeep.
2. Pharmacological Methods
When treating congestive heart failure (CHD), amiodarone is the preferred medication since it reduces ventricular arrhythmia density and improves symptoms.
Warfarin is the recommended medication for anticoagulation in congestive heart failure, and cardiologists have the most expertise in using it in congestive heart failure clinical practice.
The heart failure guidelines advocate starting beta-blockers and angiotensin-converting enzyme inhibitors (ACEI) in patients with asymptomatic left ventricle systolic dysfunction.
Conclusion
A multitude of clinical symptoms, such as bradyarrhythmias, tachyarrhythmias, stroke, heart failure, and sudden death, are linked to Chagas heart disease (CHD), which is also associated with a high mortality rate. A wide variety of clinical symptoms, from asymptomatic irregularities to severe, persistent heart failure, can be produced by Chagas cardiomyopathy, the most prevalent and severe type of chronic Chagas disease. It is also necessary to look at CHD as a potential source of cardiac problems among populations of migrants living in non-endemic nations. For these patients to receive proper care, thorough follow-up, clinical stratification, and awareness of potential CHD problems and their management are necessary.
