Association of cardiac manifestations with the severity of dengue fever

 

Chaudhari Abdul Hameed Abdul Shikur¹, Rohit Singh Mohinderpal Singh^2*

 

Abstract              Background: Cardiac manifestations in dengue virus infection can range from asymptomatic bradycardia to life threatening myocarditis. The several cardiac manifestations of dengue infection include hypotension, sinus bradycardia, rhythm abnormalities, transient ventricular arrhythmias, myocarditis, transient AV block, pericardial effusion and heart failure. Amis And Objectives: To study the association of cardiac manifestations with the severity of dengue fever. Materials And Method: In the study Patients admitted in Ward/ICU hospital having Age group of ≥ 13 years and Confirmed dengue serology (Dengue IgG / IgM / NS1 Positive) and Fulfilling the WHO criteria for dengue were selected. Total 110 patients were enrolled in the present study by calculating the sample size with 5% allowable error with 95% confidence interval and considering positive character of 37%. Patient demographic details were noted. All the necessary investigation were performed. All the patients were evaluated using two dimensional echocardiography. The evaluation was repeated on discharge in patients having abnormal findings on first echocardiography. Results: IgM and IgG were positive in 34.55% and 19.09% of the patients respectively; while NS1 was positive in 75.45% patients. Out of 110 dengue patients; 69.1% had dengue fever, 7.3% had dengue shock syndrome and 23.6% had dengue hemorrhagic fever. In the present study based on abnormal cardiac enzymes, echocardiography and ECG 60.09% of the patients were found to have cardiac manifestations. Eight patients were found to have dengue shock syndrome of which one (0.9%) had pericardial effusion while two (1.8 %) had systolic and diastolic dysfunction each. Of the 26 patients with DHF, one (0.9%) had diastolic dysfunction. The difference was statistically significant for all echocardiography findings with respect to dengue severity (P<0.05). Out of the eight patients with DSS, six patients (75%) had positive troponin I. Out of 26 patients with DHF; seven patients (26.9%) had positive troponin I. None of the patients with DF had positivity of troponin I. This indicates the percentage of dengue patients having positive troponin I correlates with severity of dengue fever. The difference was statistically significant (P<0.001). In the present study eight patients were found to have dengue shock syndrome with 87.5% of them having raised CKMB levels compared to 42.3% and 39.5% in dengue haemorrhagic fever and dengue fever respectively. This indicates the percentage of dengue patients having abnormal CKMB correlates with severity of dengue fever. The difference was statistically significant (P<0.05). In the present study all the dengue patients recovered from illness successfully and no mortality was recorded. Conclusion: Thus we conclude that ECG, cardiac enzymes and echocardiography are the main tools to diagnose the myocardial involvement in dengue fever. DHF and DSS cases had higher degree of myocardial involvement as compared to DF cases.

Key Words: cardiac manifestations, dengue, echocardiography