Rassi, Rassi and Rassi proposed an algorithm for managing heart disease in a patient with Chagas disease. The authors are from Anis Rassi Hospital in Goiania, Brazil.
Patient selection: serologic evidence for Chagas disease
Parameters:
(1) electrocardiogram
(2) NYHA functional class
(3) 2-D echocardiography for left ventricular function
(4) nonsustained ventricular tachycardia (NSVT) during 24 hours Holter monitoring
|
ECG |
NYHA |
LV Function |
NSVT |
Category |
|
normal |
NA |
NA |
NA |
1 |
|
abnormal |
I or II |
not impaired |
absent |
2 |
|
abnormal |
I or II |
not impaired |
present |
3 |
|
abnormal |
I or II |
impaired |
absent |
4 |
|
abnormal |
I or II |
impaired |
present |
5 |
|
abnormal |
III or IV |
NA |
NA |
6 |
where:
• The algorithm includes the presence or absence of cardiomegaly on chest X-ray for categories 2-5, but left ventricular function seems to trump whatever information this provides.
|
Category |
Risk Level |
Management |
|
1 |
lowest risk |
consider treating Chagas; annual or biannual exam |
|
2 |
low risk |
consider treating Chagas; annual exam |
|
3 |
low to intermediate risk |
consider treating Chagas; consider amiodarone |
|
4 |
intermediate risk |
ACE inhibitor, beta-blocker, diuretic; consider amiodarone |
|
5 |
intermediate to high risk |
as for 4, plus amiodarone; consider ICD |
|
6 |
highest risk |
as for 5, plus digitalis, espironlactone; ICD; evaluate for cardiac transplant |
Specialty: Infectious Diseases
