Chagas disease in patients with idiopathic dilated cardiomyopathy in Costa Rica
DOI:
https://doi.org/10.51481/amc.v49i2.304Keywords:
Chagasic myocarditis, dilated myocardiopathy, atrioventricular block, complex ventricular arrhythmiaAbstract
Aim: To determine the prevalence of Chagas´ disease in a group of patients from Costa Rica, with dilated myocardiopathy, bradiarrhythmias and ventricular tachyarrhythmias.
Materials and methods: We prospectively selected patients with clinical and echocardiographic diagnosis of dilated myocardiopathy, documented atrioventricular or intraventricular block or complex ventricular arrhythmias, excluding those who already had known etiologies, for example coronary artery disease or hypertensive heart disease. After obtaining an informed consent, we performed a serologic ELISA qualitative test using anti-trypanosoma cruzi antigens obtained by two different techniques.
Results: From aproximately 15,000 to 20,000 patients/year seen at the cardiology clinic of the Mexico Hospital, about 500 had dilated myocardiopathy. From February 2004 to august 2005 and excluding those patients with known causes, we recruited 74 patients, there were 41 men and 33 women with ages between 13 and 87 years (mean 47,8). Almost 70% (n=51) were included because of idiopathic dilated myocardiopathy (mean ejection fraction 29,2%), 24,3% (n=18) were included with atrioventricular block and 6,8% (n=5) with complex ventricular arrhythmia.
Five patients were positive, 3 with dilated myocardiopathy, 1 with atrioventricular blockade and 1 with complex ventricular arrhythmia. Of note, only 1 patient with dilated myocardiopathy (the only 1 in the group) had the charactersitic electrocardiographic pattern of the chronic phase of the disease: first degree atrioventricular block, right bundle branch block and left anterior division block. Antiarrhythmic management of the patient with complex ventricular arrhythmia (29 years old) was challenging. Since he did not respond to ablation and underwent sympathectomy, only to die 4 months later. There were no other differences compared with the other 69 patients.
Conclusion: The prevalence of chronic chagasic myocarditis is relatively low in patients with idiopathic myocardiopathy. This is the first time this subject is reported clinically and serologically in our country. In this entity myocardial compromise is predominant but there could also be atrioventricular blockade and complex ventricular arrhythmia cases.
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