To study the Cardiac Manifestations in Dengue Fever in Patients Admitted in KLES Dr Prabhakar Kore Hospital & M.R.C., Belgaum – A one year Hospital Based Descriptive study

Abstract

Background and objectives Dengue fever is a serious public health problem. Though dengue rarely affects heart, cardiac dysfunction with dengue fever has been described by several authors. The present study was aimed to assess the cardiac manifestations of dengue fever. Methodology This one year descriptive study was undertaken at KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum under the Department of Medicine. A total of 120 patients with either dengue IgM or IgM and IgG and NS1 positive patients admitted between January 2013 to December 2013 were studied. The assessment of cardiac manifestations was done based on electrocardiogram, 2D echocardiography and cardiac enzymes. Results Total 120 patients were enrolled in the study of which, 85 (70.83%) were males and the male to female ratio was 2.4:1. The mean age of the patients was 33.02 ± 12.71 years. The commonest clinical presentation was myalgia (97.5%). On clinical examination, 33.33% had petechiae followed by hepatomegaly and shock signs (21.6% each), pulmonary crepitations, oedema (13.33% each), hypotension (12.5%), splenomegaly (10.83%), narrow pulse pressure (10%), tachycardia (7.5%) and tachypnoea (1.67%). Cardiac manifestations was present in 36.66% patients. It was high (53.33%) in patients with dengue shock syndrome compared to the patients with dengue haemorrhagic fever (35.29%) and dengue fever (30%). A wide range of cardiac manifestations were observed in this study. CK-MB and troponin I at admission were raised in 23.3% of the patients while only CK MB and only troponin I was raised in 10% and 3.3% of the patients respectively. On ECG, at admission, 95% of the patients had normal rhythm with 84.21% with normal heart rate, 8.77% with sinus bradycardia 3.51% of the patients each with sinus tachycardia and NSST-T changes. In patient with abnormal rhythm the abnormalities noted were first degree AV block (66.67%) and RBBB (33.33%). ECG on day seven (or day of discharge whichever was earlier) showed normal rhythm and normal heart rate for all the patients. None of the patient was detected with abnormal echocardiograph. In patients with sinus tachycardia and first degree AV block all the patients (100%) had raised CK MB levels and 75% of the patients had raised troponin I levels. In those with sinus bradycardia, NSST-T changes, RBBB all the patients were found to have raised CK MB level (100%). However, Troponin I was raised in all the patients with NSST-T changes, 90% in patients with bradycardia and none of the patient with RBBB. Based on WHO criteria Dengue fever was present in 16.66%, dengue haemorrhagic fever in 70.83% and dengue shock syndrome in 12.5%. Conclusion and interpretation Transient cardiac abnormality can be an important presentation and this should guide the treating physician to look for cardiac involvement.