Chagas' disease

(Carlos Chagas, 1879 - 1934, Brazilian physician), infection caused by the protozoan Trypanosoma cruzi. It is prevalent in Central and South America, particularly in Argentina, Brazil and Chile. The course of the disease is triphasic with acute, latent and chronic periods. The acute phase may infrequently be manifested by acute myocarditis. About 20 - 30 years after acute infection, chronic Chagas' disease becomes manifested by features of dilated cardiomyopathy. This may be evident by dilated ventricles with, in some cases, more severe involvement of right-sided chambers. The most characteristic feature is left ventricular apical aneurysm.

In the chronic phase, the chest X-ray shows cardiomegaly and pulmonary venous hypertension or pulmonary oedema. Echocardiography, cine MRI and cardiac angiography reveal enlarged ventricular volumes and diminished ventricular contraction. These modalities also reveal the characteristic left ventricular apical aneurysm. Coronary arteriography is usually performed to exclude coronary arterial obstruction as the cause of the aneurysm.

CBH