What are the other Names for this Condition? (Also known as/Synonyms)

• Chagas Myocarditis
• Myocarditis due to American Trypanosomiasis
• Myocarditis due to Chagas Disease

What is Chagas Disease Myocarditis? (Definition/Background Information)

• Chagas Disease Myocarditis is an infection-mediated heart condition that results in inflammation of the heart muscles due to Chagas disease. The disease is endemic to certain regions of Latin America
• Chagas disease (or American trypanosomiasis) is caused by the parasite Trypanosoma cruzi, which is transmitted to humans via the feces of a triatomine bug (or the “kissing bug”). This insect feeds on the blood of animals and humans and subsequently urinates or defecates on the host, leaving behind T. cruzi parasites
• A parasitic transmission of T. cruzi can lead to the acute, latent, or chronic phase of the disease, potentially causing permanent damage when left untreated. While some infected individuals may not show any symptoms of Chagas disease, about 20-30% of those infected can develop serious signs, such as cardiac or digestive system problems
• Both the acute and chronic phase of the disease may involve the heart. Chagas Disease Myocarditis may cause chest pain, breathing issues, and congestive heart failure. It may result in complications that include arrhythmias, sudden heart failure, or buildup of fluid around the heart (pericardial effusion)
• The diagnosis of Chagas Disease Myocarditis may require a thorough physical checkup by the healthcare provider, blood tests, imaging studies of the heart, and an endomyocardial biopsy. Blood tests for antibodies are standard tests to diagnose chronic Chagas disease
• The treatment of Chagas Disease Myocarditis includes steroid therapy, management of arrhythmias using anti-arrhythmic medication, immunotherapy, and heart transplantation, for severe cases. Chagas disease is treated using anti-parasitic medication
• The prognosis of Chagas Disease Myocarditis may be good with appropriate treatment. However, it also depends on the phase of Chagas disease. Individuals in the acute phase generally have a better prognosis with treatment, than those in the chronic phase. In some individuals, the condition may be severe causing sudden death

Who gets Chagas Disease Myocarditis? (Age and Sex Distribution)

• Chagas Disease Myocarditis is an uncommon condition associated with Chagas disease. It is estimated that 1 in 50-60 individuals with the disease may show involvement of the heart
• Individuals of all ages, races, ethnic groups, and both genders are susceptible
• People in rural areas of Mexico, Central America and South America seem to have the highest risk of being infected

What are the Risk Factors for Chagas Disease Myocarditis? (Predisposing Factors)

Chagas Disease Myocarditis develops due to underlying Chagas disease. The potential risk factors for this parasitic infection include:

• Living in poor, rural areas of low-quality housing where the triatomine bug flourishes
• Working in a laboratory with exposure to the parasite
• Infection may be transmitted during a blood transfusion or organ transplant

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Chagas Disease Myocarditis? (Etiology)

• The cause of development of Chagas Disease Myocarditis is due to untreated or poorly-treated Chagas disease. In some cases, due to a lack of significant symptoms, Chagas disease may go undetected or unnoticed
• Both acute and chronic phases of the disease may affect the heart, although severe involvement is noted with the chronic phase that occurs many years, or even decades after the initial infection

What are the Sign and Symptoms of Chagas Disease Myocarditis?

The signs and symptoms of Chagas Disease Myocarditis vary from one individual to another; it may be mild in some and severe in others. Symptoms specific to the heart during the chronic phase may include:

• Chest pain and discomfort; acute chest pain can mimic heart attacks
• Fatigue
• Decreased ability to exercise, or decreased exercise tolerance
• Palpitations; abnormal heart beats
• Heart rhythm abnormalities (arrhythmias) including ventricular tachycardia
• If the individual has congestive heart failure, then it can result in shortness of breath, tiredness, and swelling of the extremities
• Inflammation of the heart is observed during both the acute and chronic phase of the disease

Since, Chagas disease is a systemic infection, other body systems, such as the digestive system, may also be involved causing a variety of symptoms.

How is Chagas Disease Myocarditis Diagnosed?

A healthcare provider may use some of the following methods to diagnose Chagas Disease Myocarditis:

• Complete evaluation of family (medical) history, along with a thorough physical examination, including examination of the heart
• Microscopy staining of blood smears to determine the presence of the parasite:
  • Acute Chagas disease is the only phase that is detectable using this method, as parasites may be present in the blood circulatory system during this stage
  • In latent and chronic Chagas disease, no parasites are typically found in blood (unless accompanied by a suppressed immune system, such as AIDS)
• Serological tests for antibodies to the parasite are standard tests undertaken for the diagnosis of latent and chronic Chagas disease. At least two tests are required for diagnosis, as false positives for these tests are common. Tests used for these diagnoses include:
  • Enzyme-linked immunosorbent assay (ELISA, which is commonly used to detect HIV) 
  • Immunofluorescent antibody test (IFA)
• Blood tests to evaluate the heart:
  • Calcium test and vitamin D blood level test
  • Angiotensin-converting enzyme blood test
  • Erythrocyte sedimentation rate (ESR) test
  • C-reactive protein levels in blood
  • Cardiac enzyme panel test; tests for cardiac enzymes
• Imaging studies that include:
  • Chest X-ray
  • Doppler ultrasound: Sound waves are used to measure the speed and direction of blood flow
  • CT scan of the heart
  • Contrast-enhanced MRI scan of heart
  • Positron emission tomography (PET) scan
• Echocardiography: It is an ultrasound of the heart that is performed to assess cardiac function, size of the heart chambers, and the status of heart valves 
• Electrophysiological testing
• A 12-lead electrocardiogram, physical examination, and exercise testing can be used to test for cardiac abnormalities associated with chronic Chagas disease
• Endomyocardial biopsy: A tissue biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Note: The diagnosis of Chagas disease may be difficult, as parasites are not always detectable in blood at every stage of the disease.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Chagas Disease Myocarditis?

Chagas disease may progress from acute to chronic condition, if left untreated or if treatment fails. This may result in heart palpitations and other heart abnormalities, leading to inefficient blood pumping.

Some potential complications of Chagas Disease Myocarditis include:

• Abnormal heart rhythms and conduction disorders
• Inflammation of the sac surrounding the heart (called pericarditis) and collection of fluid around the heart (called pericardial effusion)
• Sudden heart failure due to chronic form of Chagas disease (Chagas cardiomyopathy)
• Stroke and thromboembolism

How is Chagas Disease Myocarditis Treated?

Chagas Disease Myocarditis may be treated through the following measures:

• Steroid therapy; prescription of anti-inflammatory drugs
• For those with arrhythmias, anti-arrhythmic medication may be administered
• Insertion of a pacemaker for cardiac arrhythmias
• Pericardiocentesis (removal of fluid from pericardial sac) may be performed in case of pericardial effusion
• If the pumping of blood is compromised, heart transplantation may be an option, if deemed necessary by healthcare providers and specialists
• Observation and periodic checkups to monitor the condition is recommended

Treatment is recommended for all adults and children with Chagas disease, for acute, congenital, and chronic infections. Both healthy and immune-compromised individuals infected with the parasite may benefit from treatment.

How can Chagas Disease Myocarditis be Prevented?

Chagas Disease Myocarditis may be prevented by promptly diagnosing and adequately treating Chagas disease.

What is the Prognosis of Chagas Disease Myocarditis? (Outcomes/Resolutions)

The prognosis of Chagas disease is determined by whether an individual has an acute or chronic phase of infection. The outcome is generally positive for those with acute phase infection. The prognosis of Chagas Disease Myocarditis is good with early diagnosis and prompt treatment.

• If Chagas disease is left untreated or if treatment fails, it can result in damage to the major organs such as the heart
• Chagas Disease Myocarditis is known to lead to severe cardiac complications that can even be fatal

Additional and Relevant Useful Information for Chagas Disease Myocarditis:

The following article link will help you understand other heart conditions:

http://www.dovemed.com/healthy-living/heart-center/