Clinical management of chronic Chagas cardiomyopathy

Chagas disease is caused by a protozoan parasite, Trypanosoma cruzi, and infects over 15 million people worldwide. New cases of the disease are now uncommon, mainly due to national control programs in Latin America. However, there is a large reservoir of chronically infected patients, many of whom will develop chagasic cardiopathy. Here, the clinical diagnosis and management of Chagas cardiopathy are discussed. Particular emphasis is placed on the clinical staging of patients and the use of various diagnostic tests that may be useful in individualizing treatment of the two most relevant clinical syndromes, ie. heart failure and arrhythmias. Finally, the relevance of specific treatment is discussed, stressing the important role of parasite persistence for disease pathogenesis.