Acute Supraventricular Tachycardia Due to Dengue Infection: A Case Report

INTRODUCTION

Dengue hemorrhagic fever is caused by arbovirus. Its incidence has increased in tropical countries. The main vector is Aedes aegypti, which has spread due to increased urbanization.¹ Dengue virus is a single-stranded RNA virus, which exists as four serotypes 1, 2, 3, and 4. Dengue fever is the most severe viral disease, which has been emerging recently in our country.² The majority of infections have a benign clinical course. But some patients show severe clinical manifestations like bleeding and organ dysfunction. This is due to increased capillary permeability. This causes hypovolemic shock and multiorgan failure.^3,4 Electrocardiography changes are common during dengue infection.^4–6 Most of the patients are asymptomatic, but life-threatening cardiac complications are frequent in dengue hemorrhagic fever and dengue shock syndrome.^6–8 These complications can contribute to the mortality caused by dengue infection.^6,7 Atrial fibrillation (AF) (supraventricular tachycardia) is the most common type of cardiac arrhythmia seen in routine practice, which is associated with structural heart disease.^9,10 We report a case of supraventricular tachycardia AF caused by dengue viral infection.

CASE PRESENTATION

A 20-year-old female patient was admitted to the hospital with a history of fever, chills, headache, joint pain, and myalgia from 4 to 5 days. She was healthy prior to this admission and didn’t have a history of any cardiac illness, hypothyroidism, or hyperthyroidism. On examination, it was found that she had rash all over her body and she was dehydrated. Her temperature was 101°F, her blood pressure (BP) was 90/60 mm Hg, pulse rate was 54/min, regular and good in volume, and her pulse oximetry showing 98% oxygen saturation. The systemic examination was normal. Her electrocardiogram (ECG)was normal with mild bradycardia (Fig. 1), which was done at the time of admission to the hospital. She was diagnosed as dengue hemorrhagic fever and confirmed by laboratory investigation. Her laboratory parameters are mentioned in Table 1.

She was treated with intravenous normal saline and intravenous paracetamol. She was closely monitored for hematological parameters and any other bleeding tendencies. She was better during hospitalization and was improving. On the fourth day of hospitalization, she complained of palpitations. Her electrocardiogram was done, which showed supraventricular tachycardia AF (Fig. 2). Owing to the reasons, patient was administered first the bolus dose (300 mg) of amiodarone, and then constant infusion (600 mg) over the next 24 hours, intravenous amiodarone started, a 300 mg bolus and 600 mg infusion over 24 hours. After the bolus dose, her ECG was reverted back to normal sinus rhythm.

During this episode, all routine laboratory parameters were rechecked and found within normal limits. Cardiac biomarkers were within the normal limit, the complete thyroid profile was normal, and the serum electrolyte was within the normal limit (Table 2). The echocardiography (Fig. 3) and the chest radiograph were normal (Fig. 4). She was closely monitored for supraventricular tachycardia or any other cardiac arrhythmias during further hospitalization. She didn’t have any ECG changes in further hospitalization and she was comfortable. She was discharged on the seventh day. She was closely monitored to follow-up for electrocardiography changes and the follow-up electrocardiography was normal. All necessary consent and permission were taken from patient and relatives for the submission of reports to this article.

DISCUSSION

Electrocardiographic abnormalities due to dengue infection were common, and they are reported in 34–75% of cases.^5–8 These are mostly sinus bradycardia and conduction abnormalities.^5,6 Tachycardia is a normal physiological response to fever, but it is less commonly seen in dengue illness. Supraventricular tachycardia AF is rare during dengue infection.^6,7 Our patient had a typical dengue hemorrhagic fever presentation. She had thrombocytopenia, leucopenia, mild hemoconcentration, and positive dengue serological tests that confirmed her dengue illness.^5–8 Her echocardiography did not show any evidence of structural heart abnormalities such as valvular heart disease or cardiomyopathy. There were no other pathological findings in the heart. The need for antiarrhythmic therapy to restore normal sinus rhythm suggests the involvement of subclinical myocarditis even though the biomarkers of cardiac injury were normal.^8–10 Supraventricular tachycardia in our patient was due to subclinical myocarditis caused by the dengue virus.

CONCLUSION

Dengue prevalence is high in India. Physicians should be aware that supraventricular tachycardia AF may be caused by dengue infection. It is transient and self-limiting but sometimes needs a pharmacological/electric cardioversion. Patients with dengue fever need very close electrocardiographic monitoring.

ORCID

Ankush Balasaheb Kolhe https://orcid.org/0000-0002-8698-2548

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