| Renin-angiotensin-aldosterone blockers |
ACEi or ARB (for those intolerant to the former) in patients with LV systolic dysfunction, LVEF < 45%, and NYHA I/II/III/IV stages B1 to D |
I |
C |
| |
Spironolactone or eplerenone in patients with LV systolic dysfunction, LVEF < 35% and NYHA III/IV stages B2 to D |
I |
B |
| Beta blockers |
Carvedilol, bisoprolol, and metoprolol succinate in patients with LV systolic dysfunction, LVEF < 45%, and NYHA I/II/III/IV stages B2 to D |
IIa |
B |
| Diuretics |
Patients with signs and symptoms of congestion (NYHA II to IV) |
I |
C |
| Hydralazine and nitrate |
Patients of any ethnicity, with LV systolic dysfunction, LVEF < 45%, and NYHA II–IV stages B2 to D with contraindications or intolerance to ACEI and ARB (e.g., progressive renal failure or hyperkalemia) |
I |
C |
| |
Patients with LV systolic dysfunction, LVEF < 45%, and NYHA III-IV as an addition to the use of optimized therapy stages B2 to D |
IIa |
C |
| Digitalis |
Patients with LV systolic dysfunction, LVEF < 45%, and sinus rhythm or atrial fibrillation, symptomatic despite optimized therapy stages B2 to D |
IIa |
C |
| |
Patients with LV systolic dysfunction, LVEF < 45%, and AF, asymptomatic, to control high heart rate |
III |
C |
| Oral anticoagulation |
Atrial fibrillation, previous embolic events, mural thrombus, IPEC/FIOCRUZ score ≥ 4 |
I |
C |
| Amiodarone |
Patients with ventricular ectopy, asymptomatic NSVT, and left ventricular dysfunction stages B2 to D |
I |
B |
| |
Patients with symptomatic SVT or not, with or without left ventricular dysfunction not treated with ICD stages B1 to D |
I |
C |
| |
To reduce shocks in patients with ICD stages B1 to D |
I |
C |
| |
Patients with symptomatic SVT treated with CDI stages B2 to D |
IIa |
C |
| ICD |
Malignant arrhythmia, or sustained ventricular tachycardia, or those resuscitated from sudden cardiac arrest, especially with a reduced LVEF. Stages B2 to D |
I |
C |
| Resynchronization |
Refractory HF, or functional class III/IV with persistent therapeutic optimization and any evidence of dyssynchrony. Sinus rhythm, QRS duration >120 milliseconds, and LVEF <35%. Stages B2 to D |
IIb |
C |
| Heart transplantation |
Refractory HF, dependent on inotropic drugs and/or circulatory support and/or mechanical ventilation stages C to D |
I |
C |
| |
VO2 peak ≤ 10 mL/kg/min, or if in use of beta blockers with VO2 peak = 12 mL/kg/min stages C to D |
I |
C |
| |
Fibrillation or sustained refractory ventricular tachycardia stages C to D |
I |
C |
| |
Functional class III/IV with persistent therapeutic optimization stages C to D |
I |
C |
| Ventricular circulatory support |
Bridge to heart transplantation, destination therapy, or bridging to recovery. Stages C to D |
Few evidence |
Few evidence |
| Immunoadsorption (IA) |
Based on other cardiomyopathies, without evidence of CCC yet |
No evidence |
No evidence |
| Aptamers treatment |
Studies in progress |
No evidence |
No evidence |
| Specific treatment |
Acute infections, independently of the mechanism of transmission (consensual indication) |
I |
B |
| |
High-risk accidental contaminations (consensual indication) |
I |
B |
| |
Chronic phase in children (consensual indication) |
I |
B |
| |
Reactivated Trypanosoma cruzi infection—AIDS or other immunosuppression (consensual indication) |
I |
C |
| |
Congenital infection (consensual indication) |
I |
B |
| |
Organ transplantation in which either the donor or the recipient has Chagas' disease (consensual indication) |
I |
B |
| |
Late, chronic phase, including patients with the indeterminate or cardiac forms of Chagas' disease (not consensual indications) |
III |
C |
