Histopathological Analysis of the Pro-Arrhythmogenic Changes in a Suspected Chagas Disease Sudden Death

Abstract

Sudden death is the principal cause of fatality in Chagas disease, afflicting to non-symptomatic patients younger than 50-years. For
this, sudden death associated with chagasic malignant arrhythmias is underdiagnosed and their pathophysiological basis is poorly
understood.
Aims
In this sense, this work aimed to analyze the histopathological alterations in cardiac structures specialized in the generation/
conduction of action potential in an anatomopathological case of non-diagnosed sudden death living in a Chagasic endemic area.
Methods
The donor was a woman, 62-year-old, which ingressed without vital signs to the emergency room of “Antonio María Pineda”
hospital, without any apparent antecedents of cardiac disease. The gross examination was normal, with no external evidence of
structural/ischemic disease.
Results
Microscopic examination revealed nodal like cell depopulation, microvascular disturbances, chronic myocarditis with mononuclear
and mast cell infiltrate plus extracellular matrix reaction, and profuse damage of neural structures placed in nodal region.
Amastigote nest of Trypanosoma cruzi (T. cruzi) was detected.
Conclusion
These findings suggest a complex association among parasite persistence, sinus disease, micro-ischemia foci, and neural inflammation
in the genesis of malignant arrhythmias of Chagas disease despite the absence of structural disease or massive necrosis.
It is important to perform a protocol of examination for no explained sudden death cases in chagasic endemic countries, to avoid
misdiagnosed of sudden death associated with Chagas disease.