• Reinaldo B Bestetti, Tatiana A D Theodoropoulos, Augusto Cardinalli-Neto, and Patrícia M Cury.
• Outpatient Cardiomyopathy Service, Division of Cardiology, São José do Rio Preto Medical School, São José do Rio Preto City, Brazil. rbestetti@netsite.com.br
• Am. Heart J. 2008 Sep 1;156(3):422-30.

AbstractThe treatment of chronic heart failure secondary to Chagas disease has been based on extrapolation of data achieved in the treatment of non-Chagas disease heart failure. Because beta-blockers decrease the incidence of sudden cardiac death in non-Chagas disease heart failure and sudden cardiac death occurs preferentially in patients with mild Chagas disease heart failure, beta-blockers may be administered first to class I/II patients with Chagas disease heart failure. In advanced Chagas disease heart failure, angiotensin-converting enzyme inhibitor and diuretics may be given at first to compensate for congestive symptoms. After clinical status improvement, beta-blockers should be given at targeted doses, if necessary reducing angiotensin-converting enzyme inhibitor doses. Primary and secondary prevention of sudden cardiac death may be accomplished with implantable cardioverter defibrillators because of the high recurrence of life-threatening arrhythmias despite amiodarone administration. In refractory heart failure, heart transplantation is the treatment of choice.

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