Review
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Dec 26, 2021; 13(12): 654-675
Published online Dec 26, 2021. doi: 10.4330/wjc.v13.i12.654
Chagas heart disease: An overview of diagnosis, manifestations, treatment, and care
Roberto M Saraiva, Mauro Felippe F Mediano, Fernanda SNS Mendes, Gilberto Marcelo Sperandio da Silva, Henrique H Veloso, Luiz Henrique C Sangenis, Paula Simplício da Silva, Flavia Mazzoli-Rocha, Andréa S Sousa, Marcelo T Holanda, Alejandro M Hasslocher-Moreno
Roberto M Saraiva, Mauro Felippe F Mediano, Fernanda SNS Mendes, Gilberto Marcelo Sperandio da Silva, Henrique H Veloso, Luiz Henrique C Sangenis, Paula Simplício da Silva, Flavia Mazzoli-Rocha, Andréa S Sousa, Marcelo T Holanda, Alejandro M Hasslocher-Moreno, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, RJ, Brazil
Author contributions: Saraiva RM conceived and designed the article; All authors have contributed to the literature review, manuscript drafting, and critical revision of the article, and have read and approved the final manuscript.
Conflict-of-interest statement: All authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Roberto M Saraiva, MD, Senior Researcher, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Av. Brasil 4365, Rio de Janeiro 21040-900, RJ, Brazil. roberto.saraiva@ini.fiocruz.br
Received: March 18, 2021
Peer-review started: March 18, 2021
First decision: July 30, 2021
Revised: August 11, 2021
Accepted: November 28, 2021
Article in press: November 28, 2021
Published online: December 26, 2021
Abstract

Chagas heart disease (CHD) affects approximately 30% of patients chronically infected with the protozoa Trypanosoma cruzi. CHD is classified into four stages of increasing severity according to electrocardiographic, echocardiographic, and clinical criteria. CHD presents with a myriad of clinical manifestations, but its main complications are sudden cardiac death, heart failure, and stroke. Importantly, CHD has a higher incidence of sudden cardiac death and stroke than most other cardiopathies, and patients with CHD complicated by heart failure have a higher mortality than patients with heart failure caused by other etiologies. Among patients with CHD, approximately 90% of deaths can be attributed to complications of Chagas disease. Sudden cardiac death is the most common cause of death (55%–60%), followed by heart failure (25%–30%) and stroke (10%–15%). The high morbimortality and the unique characteristics of CHD demand an individualized approach according to the stage of the disease and associated complications the patient presents with. Therefore, the management of CHD is challenging, and in this review, we present the most updated available data to help clinicians and cardiologists in the care of these patients. We describe the clinical manifestations, diagnosis and classification criteria, risk stratification, and approach to the different clinical aspects of CHD using diagnostic tools and pharmacological and non-pharmacological treatments.

Keywords: Chagas disease, Diagnosis, Treatment, Heart failure, Arrhythmia, Stroke

Core Tip: Chagas heart disease (CHD) is associated with high mortality and a myriad of clinical manifestations, including bradyarrhythmias, tachyarrhythmias, stroke, heart failure, and sudden death. Therefore, adequate care of these patients requires careful follow-up, clinical stratification, and knowledge of possible CHD complications and their treatment. In this review, we present the most up-to-date available data to optimize the care of these patients. We describe the clinical manifestations, diagnosis and classification criteria, risk stratification, and approach to the different clinical aspects of CHD using diagnostic tools and pharmacological and non-pharmacological treatments.