Sudden and unexpected death in clinically `silent' Chagas' disease. A hypothesis

• Published in: International journal of cardiology Vol. 58; no. 3; pp. 263 - 268
• Main Authors: Baroldi, Giorgio, Oliveira, Samuel J.M, Silver, Malcolm D
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 01.02.1997; Elsevier Science
• Subjects: Acquired Immunodeficiency Syndrome - complications; Acquired Immunodeficiency Syndrome - pathology; Adult; Aged; Biological and medical sciences; Catecholamine cardiotoxicity; Catecholamines - physiology; Chagas Disease - complications; Chagas Disease - diagnosis; Chagas Disease - pathology; Coagulative myocytolysis; Contraction band necrosis; Death, Sudden, Cardiac - etiology; Death, Sudden, Cardiac - pathology; Endomyocardial Fibrosis - complications; Endomyocardial Fibrosis - pathology; Female; Heart Arrest - pathology; Heart Chagas' disease; Heart Failure - complications; Heart Failure - pathology; Human protozoal diseases; Humans; Infectious diseases; Lymphocytes - pathology; Male; Medical sciences; Middle Aged; Myocarditis; Myocardium - pathology; Myofibrils - pathology; Necrosis; Parasitic diseases; Protozoal diseases; Risk Factors; Sudden/unexpected death; Trypanosomiasis; Myocarditis; Coagulative myocytolysis; Catecholamine cardiotoxicity; Heart Chagas' disease; Contraction band necrosis; Sudden/unexpected death; Human; Protozoal disease; Pathophysiology; Sudden death; Chagas disease; Cardiovascular disease; Exploration; Histology; Parasitosis; Catecholamine; Myocardial disease; Infection; Pathology; Autopsy; Heart disease; Complication; Trypanosomiasis
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/S0167-5273(96)02878-1

Background: Chagas' heart disease presents an interesting model of cardiac autonomic nerve dysfunction associated with morphologic lesions. A lack of quantitative evaluation of the latter suggested this study in which hearts from 34 subjects who were serum-positive for Chagas' disease but had no clinical evidence of it and who died suddenly and unexpectedly, out-of-hospital, were examined. Methods and Results: By systematic myocardial sampling the histologic area was measured to establish: (a) the number of focal lymphocytic infiltrates×100 mm 2 and average number of lymphocytes per focus; (b) number of foci of, and myocells with, coagulative myocytolysis (contraction band necrosis) ×100 mm 2; and (c) the percentage of substitutive myocardial fibrosis. In all cases findings were: (a) intermyocellular lymphocytic infiltrates (6±6 foci×100 mm 2); (b) coagulative myocytolysis (3±5 foci and 26±56 myocells×100 mm 2). Conclusions: In all 34 subjects quantitative analysis showed extensive lymphocytic infiltrates and myocardial damage typical of catecholamine cardiotoxicity. These two acute or active histological changes may explain their sudden demise produced by focal denervation with regional asynergy and consequent compensatory adrenergic stimulus with myotoxicity and malignant arrhythmia.