Cardiac involvement with parasitic infections

Abstract

Parasitic infections previously seen only in developing tropical settings can be currently diagnosed worldwide due to travel and population migration. Some parasites may directly or indirectly affect various anatomical structures of the heart, with infections manifested as myocarditis, pericarditis, pancarditis, or pulmonary hypertension. Thus, it has become quite relevant for clinicians in developed settings to consider parasitic infections in the differential diagnosis of myocardial and pericardial disease anywhere around the globe. Chagas' disease is by far the most important parasitic infection of the heart and one that it is currently considered a global parasitic infection due to the growing migration of populations from areas where these infections are highly endemic to settings where they are not endemic. Current advances in the treatment of African trypanosomiasis offer hope to prevent not only the neurological complications but also the frequently identified cardiac manifestations of this life-threatening parasitic infection. The lack of effective vaccines, optimal chemoprophylaxis, or evidence-based pharmacological therapies to control many of the parasitic diseases of the heart, in particular Chagas' disease, makes this disease one of the most important public health challenges of our time.

FIG. 1.

ECG of a patient with CCC showing the three most typical alterations: right bundle branch block, left anterior fascicular block (large blue arrow), and ventricular extrasystole (small blue arrow). aVR, aVL, and aVF are the right lead-augmented vector, left lead-augmented vector, and lead-augmented vector foot, respectively, of the 12-lead ECG.

FIG. 2.

(A) 2D color Doppler echocardiography of a patient with CCC showing an apical left ventricular aneurysm (large white arrow) (AE is the left atrium, and VE is the left ventricle). ATL refers to the video output of the echocardiographic system of three-dimensional transesophageal echocardiography (Apogee CX 200; ATL Corp.). (B) ECG of the same patient showing anteroseptal Q waves (large blue arrow) and primary T-wave changes (mimicking coronary artery disease) (small blue arrow).