The impact of dengue fever on the heart

Mosquito-and-heart The alarming rise of dengue fever in India in recent years is a cause for serious concern. Dengue infection, though largely self-limiting is considered a dreaded disease because of its potentially fatal complications in a proportion of patients. Cardiac manifestations in dengue are reported infrequently but can be some of the serious complications that might occur during the time of defervescence. Reports from some authors claim that cardiac manifestations are characterized by spontaneous resolution. This observation does not give any relief as the commonly reported causes of mortality are multiorgan failure and shock. Though massive hemorrhage is usually reported as the cause leading to the adverse outcomes, cardiac involvement also could be an independent factor contributing to both shock and multiorgan failure.

alexander"This is a timely review on the cardiac manifestations of Dengue. Though not widely reported, it is not an uncommon manifestation of the disease and especially LV dysfunction due to myocarditis is a significant cause of mortality in many of these patients. Early recognition and treatment is an important management strategy that could improve morbidity and mortality."
-Dr. Thomas Alexander, MD, DM, FACC, FICC, FCSI, Coimbatore, Tamilnadu, India. Dr. Alexander is an interventional cardiologist who is the Head of the Division of Cardiology at Kovai Medical Center and Hospital in Coimbatore, India and is a member of the mdCurrent-India Editorial Advisory Board.

Incidence of cardiac involvement

The Indian Government has reported around 30,000 dengue cases through October 2012, more than double the statistics of 2011. Experts claim that the number of dengue cases is under-reported and estimate that annual dengue infections could be as high as 37 million! The incidence of cardiac involvement is not available. To prevent morbidity and mortality, it is important for physicians to recognize the early signs and symptoms of cardiac manifestations and initiate prompt treatment. Management of dengue illness as recommended by World Health Organization is symptomatic and supportive therapy. When there is cardiac involvement, antiarrhythmics, inotropes, and even pacemakers—temporary or permanent—may be required depending upon the nature of the problem. This makes it important to involve the cardiologist in the management of patients once cardiac involvement is suspected.

Key Point: India is posed with a challenge of the alarming rise of dengue cases. Cardiac involvement in dengue, though rare, could lead to substantial morbidity and mortality. Cardiac conditions are potentially treatable and even avoidable if signs and symptoms are recognized early.

Cardiac manifestations

Cardiac manifestations of dengue include, but are not limited to the following:

  • Cardiac arrhythmias: bradycardia, tachycardia, atrioventricular (AV) conduction disturbances, supraventricular arrhythmias
  • Myocarditis
  • Myocardial dysfunction
  • Pericarditis

Cardiac arrhythmias: A spectrum of arrhythmias have been reported to occur in dengue: sinu-atrial block, first degree AV block, Mobitz type I second degree AV block, ventricular arrhythmias, complete heart block, and atrial fibrillation. Reflective bradycardia and tachycardia secondary to myocarditis and myocardial dysfunction have...

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