[American trypanosomiasis and chronic Chagas cardiopathy at the "Ignacio Chaves" National Institute of Cardiology].

The cumulated experience at the Instituto Nacional de Cardiolog ía Ignacio Chavez during the period from 1977 to 1988 in regard of American Trypanosomiasis (AT) and its sequelae, chronic Chagasic Cardiopathy (CHC) was reviewed. There are 39 cases. One was an acute myocarditis in a child 16 months old. Three, subacute diseases among young patients and 35 cases of chronic disease with severe heart compromise. Heart failure was the most important manifestation in 19 patients. Arrhythmia was the dominant one in 8 cases. Both conditions did occur in 8, 2 had Stokes Adams syndrome as presenting complaint and one had pulmonary embolism. The surface EKG was always abnormal and heart enlargement was noted in 36 cases on chest X rays. All patients had serologic evidence of antitrypanosoma antibodies, 28 had heart reactive antibodies in their serum, 24 had polyclonal hypergammaglobulinemia and the same proportion had rheumatoid factor. Only the acute case showed another non-organ specific autoantibody. Echocardiography was useful to show dilatation of all cavities, left ones were more severely affected, abnormal movement was also detected with lower frequency, apical aneurysm and left ventricular hypertrophy were rarely detected. Fifteen out of 16 cases studied by angiogram did show normal coronary arteries, abnormal movement was demonstrated in 62% and apical aneurysm was present in 4 cases. Studies with EKG monitoring (Holter) and electrophysiology confirmed electrical abnormalities. Although once considered an exotic disease, CHC is probably underdiagnosed because the lack of methodic studies looking for epidemiologic, clinical and seroimmunologic features in patients with dilated myocardiopathy. Cardiologist practicing in south and southeast states in Mexico should be aware of this heart ailment.(ABSTRACT TRUNCATED AT 250 WORDS)