Complete Heart Block in Association with Dengue Hemorrhagic Fever

Abstract

Dengue virus infection affects the heart structurally and functionally. Clinical manifestations of cardiac complications secondary to dengue virus infection vary from self-limiting arrhythmias to severe myocardial infarction, leading to hypotension, pulmonary edema, and cardiogenic shock. However, we report a case of dengue hemorrhagic fever (DHF) complicated by a complete heart block. A female with DHF due to dengue virus serotype 2, presented to the emergency department with fever, headache, rash, and fatigue followed by an episode of syncope. She was found to have a third-degree atrioventricular block, with pulseless polymorphic ventricular tachycardia. Patient was resuscitated and a temporary trans-venous pacemaker was placed. She reverted back to normal sinus rhythm after 4 days of syncope and was subsequently discharged from the hospital after complete resolution of symptoms, without the need for a permanent pacemaker. Physicians are warranted to have high index of suspicion for dengue virus infection as an etiology in patients with acute cardiovascular compromise, especially in tropical areas.

Keywords: Dengue hemorrhagic fever; Heart block.

Fig. 1. Baseline normal sinus rhythm.

Fig. 2. Complete/third-degree heart block following syncopal attack.

Fig. 3. Polymorphic ventricular tachycardia (V-tach) without pulse.

Fig. 4. After achieving return of spontaneous circulation and placing temporary trans-venous pacemaker.