Revista portuguesa de cardiologia : orgão oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology
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Biography Historical Article
Chagas' disease and the involvement of the autonomic nervous system.
Chagas' disease is a major endemic disease in Latin America and a great cause for concern due to its high incidence: it afflicts 16 to 18 million individuals and places over 90 million people at risk of infection. At present, five mechanisms can be proposed to explain the pathogenesis of chronic Chagas cardiopathy: 1. direct lesion of the tissue by Trypanosoma cruzi; 2. dysfunction of the autonomic nervous system (neurogenic concept); 3. microvascular disease; 4. immunologic reaction; 5. alterations in the extracellular matrix. The neurogenic concept is the most attractive explanation for the pathogenesis of chronic Chagas cardiopathy through the involvement of the autonomic nervous system, an issue that has been prominent ever since Chagas first initiated research in the field. ⋯ Further evidence of autonomic nervous system dysfunction in Chagas' disease as a factor modulating complex ventricular arrhythmias was demonstrated by Pedrosa (RJ), who reported on a specific group of chronic Chagas patients with complex ventricular arrhythmias and dilated cardiopathy. In this study, when serum from chronic Chagas patients showing neither complex ventricular arrhythmias nor ventricular dilation was inoculated in isolated rabbit hearts, it produced no harmful effect in the conduction system, in contrast to what was observed in the conduction system of rabbits inoculated with serum from the Chagas patients group with complex ventricular arrhythmias and ventricular dilatation. These facts confirm Carlos Chagas as the pioneer in postulating involvement of the autonomic nervous system in Chagas' disease, and provide an important opportunity to understand ventricular involvement in chronic Chagas cardiopathy.