ISSN - 0973-0958

Pediatric Oncall Journal View Article

Cardiac Manifestations of Dengue Fever in Children
Siddappa FD1, Koushik H2, V H Ratageri1, P K Wari1.
1Department of Pediatrics, Karnataka Institute of Medical Sciences, Hubballi, India,
2Department of Pediatrics, Kasturba Medical College, Manipal, India.
Introduction: Dengue fever has varied manifestations in children of which cardiac manifestation are also known. This study was undertaken to study the cardiac manifestations of dengue in children.
Methods: This prospective study was done in Department of Pediatrics, Karnataka Institute of Medical Sciences (KIMS), Hubballi, India from December 2013 to November 2014. Inpatient children aged less than 12 years confirmed to have dengue either by a positive NS1 antigen or IgM MAC ELISA were included in the study. Those with congenital /acquired heart disease were excluded. All included children underwent cardiac assessment in form of clinical examination, serum Creatine Kinase- MB (CK-MB) level, Chest X-ray, electrocardiogram (ECG) and 2 D Echocardiography (2D Echo). Patients were classified as severe dengue, dengue with/without warning signs as per World Health Organization (WHO) criteria.
Results: Out of 39 patients with dengue, 22 (56%) children had cardiac abnormalities. Cardiac abnormalities were seen in 5 (71%) out of 7 patients with severe dengue, 7 (53%) out of 13 with dengue with warning signs and 10 (52%) out 19 with dengue without warning signs. One child had clinically overt cardiac failure. Serum CK-MB was raised in 2 (5%) patients. Left ventricular type of cardiomegaly on Chest X-ray was present in 3 (8%) children. ECG changes were present in 13 (33%) cases of which sinus tachycardia disproportionate to fever was seen in 9 (23%) patients followed by T wave inversion in 7 (17%), low QRS complex and sinus bradycardia in 2 (5%) each, ventricular ectopic and supraventricular tachycardia in 1 (2%) patient each. Abnormal 2D Echo findings were present in 11 (28%) cases with ejection fraction < 55% in 10 (25%) patients followed by left ventricular wall motion abnormality in 2 (5%) and pericardial effusion in 1 (2%). 2D Echo changes normalized by the time of discharge in 10 children except one with pericardial effusion who took 3 weeks’ time to regress..
Conclusion: Cardiac manifestations in children with Dengue are not uncommon. But, most of the cardiac involvement in children with Dengue are subclinical with sinus tachycardia and decreased ejection fraction being the commonest manifestations. There is increase in trend of cardiac manifestations among patients with severe dengue.

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