Dengue – ABC CARDIOL

IJCS

Case Report

Intermittent Left Bundle Branch Block and Cardiac Memory in a Patient with Dengue Fever: A Case Report and Literature Review

Muchtar Nora Ismail Siregar et al. Jasmine Ibtisamah Alkatiri

Abstract

Background:

Arrhythmias and Electrocardiography changes in Dengue Fever (DF) cases can mimic electrocardiogram (ECG) appearance of threatening clinical conditions such as myocardial ischemia, albeit no significant ischemic injury at the heart muscle.

Case Presentation:

We report a case of subsequent cardiac memory (CM) in a 50-year-old female with DF. A 12-lead ECG on admission revealed sinus rhythm with Left Bundle Branch Block (LBBB), and it resolved on day 4 of hospitalization. However, deep symmetric T wave inversions (TWI), which were later recognized as CM, occurred. The patient received treatment with Ringer’s lactate and paracetamol infusion. A routine 12-lead ECG performed on day 7 of hospitalization revealed the resolution of TWI and normal sinus rhythm.

Conclusion:

This case report highlights one intriguing phenomenon associated with LBBB in DF, which is CM TWI, where the T wave ‘remembers’ the direction of the QRS complex during prior abnormal ventricular activation. Due to its similarity with TWI caused by myocardial ischemia, understanding of this phenomenon may prevent unnecessary interventions.

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ABC

Case Report

Myocarditis Following Recent Chikungunya and Dengue Virus Coinfection: A Case Report

Luís Arthur Brasil Gadelha Farias et al. Francisca Lillyan Christyan Nunes Beserra Lucas Fernandes Anderson Alesxander Rodrigues Teixeira … Juliana Mandato Ferragut Evelyne Santana Girão Roberto da Justa Pires Neto

Introduction

Dengue virus (DENV) and chikungunya virus (CHIKV) are arboviruses that cause ongoing epidemics in several countries of Latin America. DENV belongs to the Flaviviridae family and CHIKV is an alphavirus of the Togaviridae family. Both viruses are transmitted by mosquitoes of the genus Aedes (mainly Aedes aegypti and Aedes albopictus) and during the acute phase they may cause similar nonspecific febrile syndromes that can progress to severe or debilitating conditions.^,

DENV infection has been endemic in Brazil since the 1980’s. However, CHIKV is an emergent agent. Autochthonous transmission was first detected in September 2014 in the city of Oiapoque, Amapá state. Since then, there have been thousands of autochthonous cases in the country. A total of 38,499 and 277,882 cases of suspected CHIKV infection were reported by the national surveillance system in 2015 and 2016, respectively. In 2017, a total of 185,369 suspected cases were reported until December 9. Ceará (1,271 cases/100,000 inhabitants) and Roraima (789 cases/100,000 inhabitants) have the highest incidence among the Brazilian Federation states. Coinfections with these two viruses have been reported and the overall effect on the heart is still unknown.^– There have been some reports of myopericarditis following DENV and CHIKV infection, but this manifestation in coinfected patients is rare and few data are available.^–

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