The treatment of chronic heart failure secondary to Chagas cardiomyopathy in the contemporary era

Abstract

<p>Chronic Heart Failure (CHF) affects about half patients with Chagas cardiomyopathy. Outcome of CHF secondary to Chagas cardiomyopathy is relentless with an annual mortality approaching 20%, which is higher than that observed in non-Chagas disease heart failure. The pathophysiology of Chagas disease is similar to that found in non-Chagas disease heart failure with a marked activation of the neurohormonal system. No randomized trial has been conducted in patients with Chagas cardiomyopathy with CHF to assess the effect of a drug on mortality of such patients. Therefore, the treatment of CHF secondary to Chagas cardiomyopathy relies on drugs prescribed to patients with non-Chagas disease heart failure<strong>. </strong>Patients with Chagas disease heart failure have been classified into stages A to D according to the American College of Cardiology/American Heart Association.  Little can be done to patients in the stage A of CHF, except for treatment of comorbidities. In patients in the stage B of CHF, aldosterone receptor antagonist, angiotensin converting enzyme inhibitors (ACEI), and Betablockers (BB) can be indicated. In patients in the stage C of CHF, the same drugs are of value. In addition, diuretics, digoxin, angiotensin receptor blockers to patients intolerant to ACEI have also been used.  Cardiac Resynchronization Therapy and Implantable Cardioverter Defibrillator may have indications similar to that of non-Chagas disease patients. In stage D of CHF, heart transplantation is a valid option for patients with this condition. </p>