Functional alterations of the autonomic nervous system in Chagas' heart disease
Keywords:
Chagas' disease, Autonomic nervous systemAbstract
Several independent pathological studies in experimental models and in human beings showed conspicuous autonomic denervation in Chagas' disease. In spite of the inherently complex structural organization of the autonomic nervous system, the parasympathetic and sympathetic divisions are involved, as shown by many functional studies. Hence, Chagas' disease represents a unique model of impairment of the autonomic control of the heart, in absence of the nonspecific effects of cardiac failure. An important limitation of the studies thus far carried out is the lack of a better knowledge of the molecular biology characteristics of different strains of T. cruzi. This could explain some geographical discrepancies found in the clinical behaviour of Chagas' disease, and contribute to a better understanding of its pathophysiology.
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ALCÂNTARA, F.G. - Denervação dos gânglios cardíacos intramurais e cervicotorácicos na moléstia de Chagas. Rev Goiana Med 16: 159-177, 1970.
ALMEIDA, H.O.; TEIXEIRA, V.P.A.; ARAUJO, W.F. & GOBBI, H. - Alterações do sistema nervoso autônomo intracardíaco em chagásicos com e sem "megas". Rev Goiana Med 29: 147-156, 1983.
AMORIM, D.S. & AMORIM, D.S. - Philogenetic approaches to the study of immunology and parasitology: some comments on potential research programs. Braz J Med Biol Res 25: 967-971, 1992.
AMORIM, D.S.; CHAMBERS, R.J.; BECK, W.; SOMERS, K.; MANÇO, J.C. & GALLO JR., L. - Comparative observations of the impairment of autonomic responses in chronic Chagas' heart disease and in African myocardiopathies. Cardiology 55: 321-332, 1970.
AMORIM, D.S.; GODOY, R.A.; MANÇO, J.C.; TANAKA, A. & GALLO JR., L. - Effects of acute elevation in blood pressure and of atropine on heart rate in Chagas'disease. A preliminary report. Circulation 38: 289-294, 1968.
AMORIM, D.S.; MANÇO, J.C.; GALLO JR., L. & MARINNETO, J.A. - Chagas' heart disease as an experimental model for studies of cardiac autonomic function in man. Mayo Clin Proc 57: 48-60, 1982.
AMORIM, D.S.; MELLO DE OLIVEIRA, J.A.; MANÇO, J.C.; GALLO JR., L. & MEIRA DE OLIVEIRA, J.S. - Chagas' heart disease: First demonstrable correlation between neuronal degeneration and autonomic impairment. Acta Cardiológica 28: 431-440, 1973.
AMORIM, D.S. & OLSEN, E.G.J. - Assessment of heart neurons in dilated (congestive) cardiomyopathy. Br Heart J 47: 11-18, 1982.
ANDRADE, Z.A. & ANDRADE, S.G. - Patologia. In: Brener, Z. & Andrade, A. eds. Trypanosoma cruzi e doença de Chagas Rio de Janeiro: Editora Guanabara Koogan SA. 1979. p. 199-248.
BÖHM, G.M. - Quantitative study of the intrinsic innervation of the heart in endomyocardial fibrosis and African idiopathic cardiopathies. Rev Inst Med Trop São Paulo 10: 84-87, 1968.
BRANDÃO, H.J.S. - Moléstia de Chagas experimental. Estudo quantitativo de neurônios simpáticos e parassimpáticos. O Hospital 61: 1014-1028, 1962.
BRASIL, A. - Autonomical .sino-atrial block: A new disturbance of the heart mechanism. Arq Bras Cardiol 8: 159-212, 1955.
CAEIRO, T.F.; PALMERO, H.A. & IOSA, D. - Estudio del reflejo barorreceptor en la enfermedad de Chagas. Medicina (Buenos Aires) 40: 27-32, 1980.
CHAGAS, C. & VILELA, E. - Forma cardíaca da tripanosomíase americana. Mem Inst Oswaldo Cruz 14: 5-61, 1922.
CHAPADEIRO, E.; LOPES, E.R. & PEREIRA, F.E.L. - Desnervação parassimpática e hipertrofia do miocárdio em chagásicos crônicos. Rev Inst Med Trop São Paulo 9: 40-42, 1967.
CICONELLI, A.J. - Estudo quantitativo dos neurônios do plexo hipogástrico inferior em ratos normais e em infectados experimentalmente pelo Trypanosoma cruzi São Paulo, 1963 [Tese - Fac Med Ribeirão Preto, USP]
ECKBERG, D.L.; DRABINSKY, M. & BRAUNWALD, E. - Defective cardiac parasympathetic control in patients with heart disease. N Engl J Med 285: 877-883, 1970.
EMDIN, M.; BIANCHINI, S.; MACERATA, A. et al. - Characterization of the cardiovascular autonomic influence through time frequency spectrum analysis. Computers in cardiology, IEEE Computer Society, 1992. p. 319-322.
EMDIN, M.; MARIN-NETO, J.A.; CARPEGGIANI, C. et al. - Heart rate variability and cardiac denervation in Chagas' disease. J Amb Monit 5:251-257, 1992.
ENGMAN, D.M.; REDDY, L.V.; DONELSON, J.E. & KIRCHHOFF, L.V. - Trypanosoma cruzi exhibits inter-and intra-strain heterogeneity in molecular karyotype and chromosomal gene location. M Bioch Paras 22: 115-123, 1987.
EWING, D.J.; CAMPBELL, LW.; BURT, A.A. & CLARKE, B.F. - Vascular reflexes in diabetic autonomic neuropathy. Lancet II: 1354-57, 1973.
FARIA, M.A.M.; SILVA, E.R. & DIAS, C.E.N. - Efeitos da acetil-beta-metil-colina (metacolina) em pacientes com a infecção crônica pelo T. cruzi Estudo eletrocardiográfico controlado. Rev Inst Med Trop São Paulo 10: 171-177, 1968.
FERREIRA, A.L. - Alterações do testículo e do epidídimo de cobaias infectados experimentalmente com Trypanosoma cruzi 1968 [Tese - Fac Med Ribeirão Preto, USP]
GAAN, D.; MAHONEY, M.P.; ROWLANDS, D.J. & JONES, A.W. - Postural hypotension in amyloid disease. Am Heart J 84: 395-400, 1972.
GALLO JR., L.; MACIEL, B.C.; MANÇO, J.C. & MARINNETO, J.A. - Limitations of facial immersion as a test of parasympathetic activity in man. J Physiol 396: 1-10,1988.
GALLO JR., L.; MARIN-NETO, J.A.; MANÇO, J.C.; RASSI, A. & AMORIM, D.S. - Abnormal heart rate responses during exercise in patients with Chagas' disease. Cardiology 60: 147-162, 1975.
GALLO JR., L.; MORELO-FILHO, J.; MACIEL, B.C. et al. - Evaluation of the autonomic nervous system of the heart in male patients with mitral valve prolapse syndrome using respiratory sinus arrhythmia and dynamic exercise. Cardiology 76: 433-441, 1989.
GALLO JR., L.; MORELO-FILHO, J.; MACIEL, B.C.; MARIN-NETO, J.A.; MARTINS, L.E.B. & LIMA-FILHO, E.C. - Functional evaluation of sympathetic and parasympathetic system in Chagas' disease using dynamic exercise. Cardiovasc Res 21: 922-927, 1987.
GOLDSTEIN, R.E.; BEISER, G.D.; STAMPFER, M. & EPSTEIN, S.E. - Impairment of autonomically mediated heart rate control in patients with cardiac dysfunction. Circ Res 36: 571-578, 1975.
GOMEZ, E.; VALDEZ, A.M.; PINERO, D. & HERNANDEZ, R. - What is a genus in the Trypanosomatidae family? Philogenetic analysis of two small rRNA sequences. M Biol Evol 8: 254-259, 1991.
GUEVARA, J.F.; BLANDÓN, R.; JOHNSON, C.M.; SOUSA, H.O. & LEANDRO, I. - Aspectos clínicos, anatomopatológicos y terapéuticos de la enfermedad de Chagas en Panamá. Arq Bras Cardiol 30: 140, 1977.
IOSA, D.J.; CAIEIRO, T.; PALMERO, H. et al. - Abnormal hyperventilation test in chronic Chagas' disease. J Aut New Syst 2: 87-92, 1980.
JUNQUEIRA JR., L.F.; GALLO JR., L.; MANÇO, J.C.; MARIN-NETO, J.A. & AMORIM, D.S. - Subtle cardiac autonomic impairment in Chagas' disease detected by baroreflex sensitivity testing. Braz J Med Biol Res 18: 171-178, 1985.
KÖBERLE, F. - Cardiopathia parasympaticopriva. München Med Wschr 101: 1308, 1959.
KÖBERLE, F. - Enteromegaly and cardiomegaly in Chagas'disease. Gut 4: 399-405, 1963.
KÖBERLE, F.; COSTA, R.B.; OLIVEIRA, J.A.M. & OLIVEIRA, J.S.M. - Patologia da moléstia de Chagas. Medicina (CARL) 5: 5, 1972.
KRIEGER, E.M. &; ALCANTARA, F.G. - The autonomic heart rate regulation of rats with chronic Chagas' disease. Acta Physiol Lat Am 11: 260, 1961.
LOPES, E.R. - Contribuição ao estudo dos gânglios cardíacos (sistema nervoso autônomo) em chagásicos crônicos. Hospital (Rio) 70: 265, 1966.
LOPES, E.R. - Estudo comparativo dos gânglios subepicárdicos nas cardiopatias chagásicas crônica, reumática e hipertensiva. Rev Inst Med Trop São Paulo 12: 365, 1970.
LOPES, E.R.; CHAPADEIRO, E.; ALMEIDA, H.O. & ROCHA, A. -: Contribuição ao estudo da anatomia patológica dos corações chagásicos falecidos subitamente. Rev Soc Bras Med Trop 9: 269-282, 1975.
LOPES, E.R.; CHAPADEIRO, E. & ROCHA, A. - Anatomia patológica do coração na forma indeterminada. In: Cançado, J.R. & Chuster, M. eds. Cardiopatia Chagásica Fundação Carlos Chagas, Belo Horizonte, MG, 1985.
LOPES, E.R. & TAFURI, W.L. - Involvement of the autonomic nervous system in Chagas' heart disease. Rev Soc Bras Med Trop 16: 206, 1983.
MACHADO, C.R.S.; MACHADO, A.B.M. & CHIARI, C.A. - Recovery from heart norepinephrine depletion in experimental Chagas' disease. Am J Trop Med Hyg 27: 20-24, 1978.
MANÇO, J.C.; GALLO JR., L.; GODOY, R.A.; FERNANDES, R.G. & AMORIM, D.S. - Degeneration of the cardiac nerves in Chagas'disease. Further studies. Circulation 40: 879-885, 1969.
MARIN-NETO, J.A. - Respostas circulatórias a alterações passivas de postura ("tilting test") na cardiopatia chagásica crônica 1975. 156 p. [Tese - Fac Med Ribeirão Preto, USP]
MARIN-NETO, J.A.; GALLO JR., L.; MANÇO, J.C.; RASSI, A. & AMORIM, D.S. - Mechanisms of tachycardia on standing: studies in normals individuals and in chronic Chagas' heart patients. Cardiovasc Res 14: 541-550, 1980.
MARIN-NETO, J.A.; GALLO JR., L.; MANÇO, J.C.; RASSI, A. & AMORIM, D.S. - Postural reflexes in chronic Chagas' heart disease. Heart rate and arterial pressure responses. Cardiology 60: 343-357, 1975.
MARIN-NETO, J.A.; MACIEL, B.C.; GALLO JR., L.; JUNQUEIRA JR., L.F. & AMORIM, D.S. - Effect of parasympathetic impairment on the haemodynamic response to handgrip in Chagas' heart disease. Brit Heart J 55: 204-210, 1986.
MARIN-NETO, J.A.; MACIEL, B.C.; GALLO JR., L.; MANÇO, J.C.; TERRA-FILHO, J. & AMORIM, D.S. - Effect of lowering left atrial pressure on the arterial baroreflex control of heart rate in patients with congestive heart failure. In: Sleight, P. ed. Arterial Baroreceptors and Hypertension Oxford University Press, England, 1980: p. 499-509.
MARIN-NETO, J.A.; MARZULLO, P.; MARCASSA, C. et al. - Myocardial perfusion abnormalities in chronic Chagas' disease. Assessment with Thallium-201 scintigraphy. Am J Cardiol 69: 780-784, 1992.
MARIN-NETO, J.A.; PINTYA, A.O.; GALLO JR., L. & MACIEL, B.C. - Abnormal baroreflex control of heart rate in decompensated congestive heart failure and reversal after compensation. Am J Cardiol 67: 604-610, 1991.
MENEGHELLI, U.G. - Chagas'disease: a model of denervation in the study of digestive tract motility. Brazilian J Med Biol Res 18: 255-264, 1985.
MILES, M.A.; PÓVOA, M.M.; PRATA, A.; CEDILLOS, R.A.; SOUZA, A.A. & MACEDO, V. - Do radically dissimilar Trypanosoma cruzi strains (Zymodemes) cause Venezuelan and Brazilian forms of Chagas' disease? The Lancet, 1338-1340, 1981.
MOTT, K.E. & HAGSTROM, J.W.C. - The pathologic lesions of the cardiac autonomic nervous system in chronic Chagas myocarditis. Circulation 31: 273-286, 1965.
OLIVEIRA, J.S.M. - A natural human model of intrinsic heart nervous system denervation: Chagas' cardiopathy. Am Heart J 110: 1092-1098, 1985.
OLIVEIRA, J.S.M. - Cardiopatia chagásica experimental. Rev Goiana Med 15: 77-133, 1969.
PAGANO, M.A.; BASSÓM, S.; ARISTIMUÑO, G.G.; COLOMBI, A. & SICA, R.E.P. - Electromyographical findings in human chronic Chagas'disease. Arq Neuro-Psiquiat 36: 316, 1978.
OLIVEIRA, J.S.M. & KÖBERLE, F. - Vinte e cinco anos da teoria neurogênica. In: Modernos Conhecimentos sobre Doença de Chagas. Op cit, 248-272.
PALMERO, H.A.; CAEIRO, T.F. & IOSA, D.J. - Distinctive abnormal responses to tilting test in chronic Chagas' disease. Klin Wochenschr 58: 1307-1311,1980.
PALMERO, H.A.; CAIEIRO, T.F.; IOSA, D.J. et al - Effect of Chagas' disease on arterial blood pressure. Am Heart J 97: 38-42, 1979.
PALMERO, H.A.; IOSA, D.J. & CAEIRO, T.F. - Disfunción del sistema nervioso autónomo en la enfermedad de Chagas crónica. Rev Arg Cardiol 47: 152-159, 1979.
PINTYA, A.O.; MARIN-NETO, J.A.; MACIEL, B.C. & GALLO JR., L. - Parassistolia em cardiopatas chagásicos crônicos com disritmia ventricular. Arq Bras Cardiol 44: 261-265, 1985.
RAMOS, J.A. & CARVALHAL, S. - Moléstia de Chagas. Evolução de conceito. In: Cançado, J.R. ed. Doença de Chagas Belo Horizonte, Minas Gerais, Brasil, 1968: p. 401-420.
RIBEIRO JORGE, RA.; MODESTO, N.P. & CARVALHAL, S.S. - Sobre os neurônios e a coronariografia "post-mortem" na cardiopatia chagásica crônica. Arq Bras Cardiol 23:101-108, 1970.
RIBEIRO DOS SANTOS, R. & SILVA, J.S. - Doença de Chagas: resposta imune humoral e celular. Rev Goiana Med 26: 115-213, 1980.
SARNOFF, S.J. & MITCHELL, J.H. - The regulation of the performance of the heart. Am J Med 34: 147-154, 1961.
SICA, R.E.P.; FILIPINI, D.; PANIZZA, M. et al - Involvement of the peripheral sensory nervous system in human chronic Chagas'disease. Medicina (Buenos Aires) 46: 662-668, 1986.
SOUSA, A.C.S.; MARIN-NETO, J.A.; MACIEL, B.C.; GALLO JR., L. & AMORIM, D.S. - Cardiac parasympathetic impairment in gastrointestinal Chagas' disease. The Lancet, I-8539: 985, 1987.
STRATTON, J.R.; PFEIFFER, M.A. & HALTER, J.B. - The hemodynamic effects of sympathetic stimulation combined with parasympathetic blockade in man. Circulation 75: 922-929, 1987.
SUÁREZ, J.A. - Los ganglios neurovegetativos intracardíacos en la patogenia de la miocarditis chagásica. Gaz Med Bahia 69: 73-104, 1969.
TAFURI, W.L. - Contribuição da microscopia eletrônica para o conhecimento da patogenia da doença de Chagas experimental humana. In: Modernos Conhecimentos sobre Doença de Chagas. Op cit, 1981. p. 221-235.
TAFURI, W.L. - Light and electron microscope studies of the autonomic nervous system in experimental and human American trypanosomiasis. Virchows Arch Abt A Path Anat 354: 136-149, 1971.
TAFURI, W.L. - Pathogenesis of lesions of the autonomic nervous system of the mouse in experimental acute Chagas' disease. Am J Trop Med Hyg 19: 405-417, 1970.
TAFURI, W.L. & BRENER, Z. - Lesões do sistema nervoso autônomo do camundongo albino na fase crônica da tripanosomíase cruzi experimental. Rev Inst Med Trop São Paulo 8: 177-183, 1966.
VIEIRA, C.B. - A forma nervosa crônica da doença de Chagas vista pelo clínico geral. Rev Goiana Med 12: 31-48, 1966.
