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Insights into the clinical and functional significance of cardiac autonomic dysfunction in Chagas disease.

Abstract：

INTRODUCTION:Exclusive or associated lesions in various structures of the autonomic nervous system occur in the chronic forms of Chagas disease. In the indeterminate form, the lesions are absent or mild, whereas in the exclusive or combined heart and digestive disease forms, they are often more pronounced. Depending on their severity these lesions can result mainly in cardiac parasympathetic dysfunction but also in sympathetic dysfunction of variable degrees. Despite the key autonomic effect on cardiovascular functioning, the pathophysiological and clinical significance of the cardiac autonomic dysfunction in Chagas disease remains unknown. METHODS:Review of data on the cardiac autonomic dysfunction in Chagas disease and their potential consequences, and considerations supporting the possible relationship between this disturbance and general or cardiovascular clinical and functional adverse outcomes. RESULTS:We hypothesise that possible consequences that cardiac dysautonomia might variably occasion or predispose in Chagas disease include: transient or sustained arrhythmias, sudden cardiac death, adverse overall and cardiovascular prognosis with enhanced morbidity and mortality, an inability of the cardiovascular system to adjust to functional demands and/or respond to internal or external stimuli by adjusting heart rate and other hemodynamic variables, and immunomodulatory and cognitive disturbances. CONCLUSIONS:Impaired cardiac autonomic modulation in Chagas disease might not be a mere epiphenomenon without significance. Indirect evidences point for a likely important role of this alteration as a primary predisposing or triggering cause or mediator favouring the development of subtle or evident secondary cardiovascular functional disturbances and clinical consequences, and influencing adverse outcomes.

journal_name

Rev Soc Bras Med Trop

journal_title

Revista da Sociedade Brasileira de Medicina Tropical

authors

Junqueira LF Jr

doi

10.1590/s0037-86822012000200020

subject

Has Abstract

pub_date

2012-03-01 00:00:00

pages

243-52

issue

eissn

0037-8682

issn

1678-9849

pii

S0037-86822012000200020

journal_volume

pub_type

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Insights into the clinical and functional significance of cardiac autonomic dysfunction in Chagas disease.