Neglected tropical cardiomyopathies, Chagas disease: Myocardial disease

Abstract

Cardiomyopathies, defined as diseases of the myo- cardium associated with cardiac dysfunction, are classified into dilated, hypertrophic, restrictive and arrhythmogenic right ventricular cardiomyopathy, as well as unclassified. 1 More recently, molecular classification has been suggested. 2 Cardiomyopathies continue to be a significant cause of morbidity and mortality in the developed world. w1 In developing countries, however, there appears to be an increased incidence of the ‘‘usual’’ forms of cardiomyopathy, with a modified clinical course possibly due to genetic differences or environmental factors such as malnutrition, infections and pollution. w2 In addition, there are specific cardiomyopathies endemic to the tropics such as Chagas and endomyocardial fibrosis, which cause a considerable amount of death and suffering and have been classified as neglected diseases. We here describe what is known about these two diseases, their aetiologies, pathogenesis and management and outline directions for further research. The present article will discuss Chagas disease, and a subsequent article will address endomyocardial fibrosis.