Study of Proportion of Cardiac Involvement Secondary to Dengue Infection in Pediatric Population Admitted in a Tertiary Hospital- A Prospective Cross-Sectional Study

Background- Dengue is one of the most important mosquito-borne illnesses worldwide. Cardiac manifestations of dengue illness can range from asymptomatic bradycardia to life-threatening myocarditis. There is an overall paucity of published Indian studies of clear demonstration of cardiac manifestations secondary to dengue in the pediatric population. Aim- To study the proportion of patients with cardiac involvement secondary to dengue viral infection in the pediatric age group based on clinical manifestations of cardiac enzymes (CKMB, Troponin I) and ECG (electrocardiography), in a tertiary center. Methodology- This study is undertaken to find out the proportion of patients with cardiac manifestations secondary to dengue in the pediatric population aged between 1 to 18 years admitted in a tertiary center. A total of 51 patients who had positive tests for dengue (NS1 or IgM antibody) with or without IgG positive were included in the study. Cardiac enzymes i.e. CK MB and Troponin I were done for all dengue patients at the time of admission. Also, repeat CK-MB and Troponin I were done on day 3 and at any time if the patient has new emerging cardiac symptoms like chest pain, oedema, hypotension and arrhythmia. If any abnormalities are detected on ECG and/or of levels of cardiac enzymes, 2D cardiac echography was done to assess cardiac function. Results-Sinus bradycardia was the predominant manifestation of ECG in dengue viral fever patients. 13.7% (n=7) had abnormal ECG on day 3 of admission. Out of these 7 patients, 85.71% were in the recovery phase and 1.96% were in the critical phase of dengue at that time. There was a significant association between CK-MB and clinical cardiac manifestations at the time of admission. It was observed that there was no correlation between cardiac biomarkers and ECG or 2D echocardiography findings. Conclusion- Patients manifest with a variety of clinical features suggesting cardiac involvement many of which overlap with other complications of the condition. Cardiac involvement in dengue fever is often underdiagnosed owing to a low index of clinical suspicion, its overlapping clinical manifestations and low sensitivity and specificity of clinical features of myocarditis.