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Stroke in Chagas disease: from pathophysiology to clinical practice

Authors
  • Lage, Thaís Aparecida Reis1
  • Tupinambás, Julia Teixeira1
  • de Pádua, Lucas Bretas2
  • Ferreira, Matheus de Oliveira2
  • Ferreira, Amanda Cambraia3
  • Teixeira, Antonio Lucio1, 4
  • Nunes, Maria Carmo Pereira1, 2
  • 1 Universidade Federal de Minas Gerais, Programa de Pós-Graduação em Ciências da Saúde, Infectologia e Medicina Tropical, Belo Horizonte, Minas Gerais , Brasil.
  • 2 Universidade Federal de Minas Gerais, Faculdade de Medicina, Belo Horizonte, Minas Gerais, Brasil.
  • 3 Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil.
  • 4 University of Texas, Health Science Center at Houston, Neuropsychiatry Program, Houston, United States of America.
Type
Published Article
Journal
Revista da Sociedade Brasileira de Medicina Tropical
Publisher
Sociedade Brasileira de Medicina Tropical - SBMT
Publication Date
Jun 06, 2022
Volume
55
Identifiers
DOI: 10.1590/0037-8682-0575-2021
PMID: 35674560
PMCID: PMC9176734
Source
PubMed Central
Keywords
Disciplines
  • Mini Review
License
Unknown

Abstract

Despite substantial progress toward its control, Chagas disease continues to be a major public health problem in Latin America and has become a global health concern. The disease affects approximately 6 million people, of whom 20-40% will develop cardiomyopathy over the years after the initial Trypanosoma cruzi infection. Chagas cardiomyopathy is the most serious and frequent manifestation of Chagas disease. Clinical manifestations vary widely according to the severity of myocardial dysfunction, ranging from asymptomatic to severe forms, including dilated cardiomyopathy with heart failure, arrhythmias, thromboembolism events, and sudden death. Chagas disease is a risk factor for stroke regardless of the severity of cardiomyopathy, which is a leading cause of chronic disability. Classically, stroke etiology in patients with Chagas disease is thought to be cardioembolic and related to apical aneurysm, mural thrombus, and atrial arrhythmias. Although most strokes are thromboembolic, other etiologies have been observed. Small vessel disease, atherosclerosis, and cryptogenic diseases have been reported in patients with Chagas disease and stroke. The potential mechanisms involved in non-embolic strokes include the presence of associated risk factors, pro-inflammatory and prothrombotic disease states, and endothelial dysfunction. However, the contribution of each mechanism to stroke in Chagas disease remains unclear. The review aims to provide an overview of stroke in Chagas disease, highlighting the main pathophysiological mechanisms, clinical presentation, approaches for prevention, and unanswered questions regarding treatment strategies.

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