Cardiologie clinique et expérimentale
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Histopathological Analysis of the Pro-Arrhythmogenic Changes in a Suspected Chagas Disease Sudden Death

Hector O. Rodríguez A

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. 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. The donor was a woman, 62 years old, which ingresses without vital signs to
the emergency room of “Antonio María Pineda” hospital. The gross examination was normal, with no external
evidence of structural/ischemic disease. Microscopic examination revealed nodal cell depopulation, micro vascular
disturbances, chronic cardiomyopathy with mononuclear and mast cell infiltrate plus extracellular matrix reaction
and profuse damage of neural structures placed in nodal region. Amastigote nest was detected. 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.