Current features of cardiac symptoms in African trypanosomiasis in humans due to Trypanosoma gambiense (194 cases)

This study is based on clinical and electrocardiographical documents collected in 194 cases of confirmed trypanosomiasis, on X rays documents in 118 cases, on anatomopathological documents in 11 cases, on mechanogram documents in 13 cases and on a hemodynamic and angiocardiographic study of 5 trypanosomiasis patients. Clinical symptomatology is frequent but often not very obvious. Among the functional symptoms, one can note the frequency of atypical precordial pains. The physical cardiac symptoms often belong to the myocarditis kind. The peripheric physical symptoms often show a pinched arterial blood pressure especially in the standing position, while the stasis is unfrequent. The X ray symptomatology includes medium sized hearts (44.9%), large ones (33.8%) and rather unexpectedly small ones (21.2%). With angiocardiographic observation a concentric muscular hypertrophy can be noticed in 3 cases out of 5, and in one case, on the contrary, the myocard is thinned. The electrocardiographic symptomatology has been studied in previous publications. It has been observed in 35% of cases and affects mainly the T wave (85% of cases) and the ST segment (12% of cases). The manifestations of hypertrophy, strain, ischemia and the extrasystoles are less frequent. Conduction disorders (other than right incomplete heart blocks) have been observed in 3.7% of cases, 2 complete bundle branch blocks and 5 auriculo ventricular ones. Their main interest lies in the fact that they very likely are of the inflammatory kind, with a possibility of being cured by the corticoids. The mecanogram study of 13 cases allows us to notice a lengthening of the pre ejectional phase and more especially of the transformational phase. The hemodynamical study of 5 cases of trypanosomiasis doesn't show any striking anomalies with patients whose heart disorders haven't been decompensated. Anatomopathological documents show enlarged hearts or reduced ones with concentric muscular hypertrophy with sometimes a slight pericardial effusion. Under the microscope, the manifestations are mostly of the inflammatory and fibrous in type. Finally, the retrospective study of the files of 22 deceased patients allows us to state that: on the one hand arsenical encephalopathy (4 cases) has been noticed with patients whose cardiovascular (as well as general and neurological) condition isn't seriously impaired, and that on the other hand death due to the evolution of trypanosomiasis occurs with subjects having serious heart disorders (as well as serious general and neurological symptoms).