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Precordial chest pain in patients with chronic Chagas disease

Reinaldo B Bestetti1, Carolina Baraldi A Restini1

  • 1Medical Course, University of Ribeirão Preto, Brazil. Avenida Costábile Romano, 2201, Ribeirão Preto City 14096-900, Brazil.

International Journal of Cardiology
|August 16, 2014
PubMed

Insights

Precordial chest pain is common in chronic Chagas disease, often mimicking acute coronary syndrome. Microvascular angina is the likely cause, and specific medications may help manage this symptom.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Clinical Medicine

Background:

  • Precordial chest pain affects 15-33% of patients with chronic Chagas disease.
  • This pain, when megaesophagus is absent, is attributed to chronic Chagas heart disease.
  • Atypical features include lack of exercise association and no relief from nitroglycerin.

Purpose of the Study:

  • To explore the characteristics and potential mechanisms of precordial chest pain in chronic Chagas disease.
  • To investigate the differential diagnosis, particularly distinguishing it from acute coronary syndrome.
  • To review potential therapeutic strategies for this symptom.

Main Methods:

  • Review of previously reported cases and clinical data.
  • Analysis of patient presentations and response to treatments.
  • Differential diagnosis considering obstructive coronary artery disease and microvascular angina.

Main Results:

  • Precordial chest pain can present atypically, sometimes resembling acute coronary syndrome.
  • Microvascular angina is identified as a probable underlying mechanism, even without obstructive coronary artery disease.
  • The condition may not always have a benign course and can indicate a poor prognosis.

Conclusions:

  • Precordial chest pain in Chagas disease warrants careful evaluation due to its potential severity.
  • Microvascular angina is a key consideration in the pathophysiology.
  • Nitrates, beta-blockers, and calcium channel blockers may be beneficial treatments.

Keywords:
Chagas cardiomyopathyChagas diseaseChest painMegaesophagus

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