Consideraciones sobre el manejo de la insuficiencia cardíaca crónica en la enfermedad de Chagas

Chagas disease is one of the main public health problems today in Central and South American countries. Patients infected with Trypanosoma cruzi who develop severe myocardial damage have a high risk of mortality from heart failure or sudden death. The continuous presence of low loads of the parasite, the immune response, alteration of the coronary microvasculature, and heart disautonomy are the proposed mechanisms explaining the development of a cardiomyopathy in the chronic phase. Other investigations suggest that the abnormalities of the parasympathetic nervous system and sympathetic prevalence present in Chagas cardiopathy are preceded by myocardial damage, similarly as in other cardiopathies in dilated phase, where this neurohumoral activation would contribute to theprogress of the cardiomyopathy; and that favorable results in the natural course of the illness can be obtained with the use of medication for the control of this activity. Currently, there are few studies assessing the benefits of medications for the treatment of heart failure in Chagas cardiomyopathy, but evidence from randomized follow-up and observational studies suggests that medications such as angiotensin converting enzyme inhibitors, beta blocker adrenergic and antiarrhythmics like amiodarone, among others, are effective and safe for the treatment of this cardiopathy.