CLINICAL AND MORPHOLOGICAL-CHARACTERISTICS ASSOCIATED WITH SUDDEN CARDIAC DEATH IN PATIENTS WITH CHAGAS-DISEASE

The medical records of 24 patients with Chagas disease who died suddenly; between 1982 and 1988, were examined in an attempt to determine the clinical profile of sudden death in Chagas disease Patient age ranged from 33 to 72 years (average: 51). Seventeen (70%) were male. Five (20%) were asymptomatic. Dyspnoea at rest was observed in l6 (66%) and palpitations in eight (33%). On physical examination, arrhythmias were observed in 14 (58%) ankle swelling in 13 (54%) and liver enlargement in 12 (50%) patients. Twenty-three (95%) patients had an abnormal resting electrocardiogram: ventricular premature contractions were observed in l9 patients (79%) and a left anterior fascicular block in 14 (58%). The chest X-ray revealed cardiomegaly in 20 patients (82%), which was moderate in three (13%) and severe in 11 (45%). At autopsy mean heart weight was 496g. Dilatation of all cardiac chambers was detected in 22 (91%), and apical aneurysm in 19 (79%) patients. When compared with symptomatic patients asymptomatic patients with Chagas disease had a higher frequency of normal physical examination (3/5vs1/19, P< 0.004), normal chest X-ray (3/5 vs1/19, P< 0.01), and a lower heartweight (400 + 43 g vs 521.58 + 146.26 g, P< 0.03). The majority of patients with Chagas disease who die suddenly have severe underlying myocardial disease. In some of them, however, sudden cardiac death may occur in the presence of minimal, if any heart involvement.