Study of cardiac function in adults with dengue
Keywords:DF, Cardiac abnormalities, ECG, 2 D echo
Background: Medical literature has reports of isolated cases of atrioventricular conduction disorders, supraventricular arrhythmias, and myocarditis in dengue fever (DF). There is a paucity of data available in the published literature on the cardiac manifestations of DF from India. The aim of the present study was to assess the cardiac manifestations of DF.
Methods: The 140 patients aged ≥18 years with DF confirmed with a serology-dengue non-structural protein 1 antigen-positive were included for this prospective observational study. Three serial ECGs were taken on day one, day three and day seven or day of discharge. All the patients were evaluated using 2D echo on day one, day seven or day of discharge. The primary outcome measures were to find the incidence and type of echocardiographic abnormalities and electrocardiographic changes in dengue.
Results: The incidence of cardiac abnormalities on ECG and 2D echo was 30 (21.4%), and 5 (7.0%) respectively. On ECG, 14 (10%) 9 (6.4%) 3 (2.1%) 3 (2.1%) and 1 (0.7%) patients had sinus bradycardia, sinus tachycardia, non-specific ST-T changes, right bundle branch block and atrio-ventricular block respectively. On 2D echo, 7 (5.0%), 5 (3.6%) and 1 (0.7%) patient had systolic dysfunction, ejection fraction (<45.0%) and diastolic dysfunction respectively.
Conclusions: The incidence of cardiac abnormalities on ECG and 2D ECHO in dengue patients was considerable. ECG and 2 D echo should be undertaken in patients with DF.
Nagaratnam N, Siripala K, De Silva N. Arbovirus (dengue type) as a cause of acute myocarditis and pericarditis. Br Heart J. 1973;35(2):204-6.
Pesaro AE, D’Amico É, Aranha LFC. Dengue: cardiac manifestations and implications in antithrombotic treatment. Arq Bras Cardiol. 2007;89(2):e12-5.
Arora M, Patil RS. Cardiac Manifestation in Dengue Fever. J Assoc Physicians India. 2016;64(7):40-4.
Barniol J, Gaczkowski R, Barbato EV, da Cunha RV, Salgado D, Martínez E et al. Usefulness and applicability of the revised dengue case classification by disease: multi-centre study in 18 countries. BMC Infect Dis. 2011;11:106.
Hadinegoro SR. The revised WHO dengue case classification: does the system need to be modified? Paediatr Int Child Health. 2012;32(1):33-8.
Charan J, Biswas T. How to calculate sample size for different study designs in medical research? Indian J Psychol Med. 2013;35:121-6.
Yacoub S, Wertheim H, Simmons CP, Screaton G, Wills B. Cardiovascular manifestations of the emerging dengue pandemic. Nat Rev Cardiol. 2014;11:335-45.
Sukhwani N, Chhari R. Cardiac involvement in patients of dengue fever in reference to ECG and Echocardiography-A tertiary care center study. Int J Med Res Rev. 2020;8(6):392-7.
Wali JP, Biswas A, Chandra C, Malhotra A, Aggarwal P, Handa R et al. Cardiac involvement in Dengue Haemorrhagic Fever. Int J Cardiol. 1998;64:31-6.
Datta G, Mitra P. A Study on Cardiac Manifestations of Dengue Fever. J Assoc Physicians India. 2019;67:14-6.
Mansanguan C, Hanboonkunupakarn B, Muangnoicharoen S, Huntrup A, Poolcharoen A, Mansanguan S et al. Cardiac evaluation in adults with dengue virus infection by serial echocardiography BMC Infect Dis. 2021;21:940.
Gupta VK, Gadpayle AK. Subclinical cardiac involvement in dengue haemorrhagic fever. J Indian Acad Clin Med. 2010;11(2):107-1.
Sheetal S, Jacob E. A Study on the Cardiac Manifestations of Dengue J Assoc Physicians India. 2016;64(5):30-4.