Cardiovascular Journal of Africa: Vol 32 No 5 (SEPTEMBER/OCTOBER 2021)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 5, September/October 2021 278 AFRICA study inclusion criteria and we selected: seven observational studies, eight case series, 11 case reports, one narrative review and one systematic review. From manual reference lists search, two additional documents were selected. A table (Table 1) of the original articles was made with the principal CV findings in dengue. Interobserver variability was assessed using Cohen’s kappa. Percentage overall agreement was 85%; free-marginal kappa was 0.70 (0.38, 1.00) (moderate) for observers. Epidemiology of cardiovascular manifestations CV manifestations of dengue are uncommon and almost Table 1. Summary of original studies selected presenting cardiovascular complications of dengue Study (year) Type of study (participants) Country Disease severity Cardiovascular findings Co-morbidities Datta et al. (2019) Prospective study ( n = 15) India Asymptomatic ( n = 4) Symptomatic ( n = 11) Asymptomatic sinus bradycardia ( n = 4); symptomatic bradyarrhythmias ( n = 4); left ventricular systolic dysfunction (ejection fraction 35–45%) ( n = 4); pericardial effusion ( n = 2); atrial fibrillation ( n = 1) Not reported Wali et al. (1998) Cohort ( n = 17) India Severe ( n = 17) Ejection fraction < 40% ( n = 7); global hypokinesia ( n = 12); ST and T changes in the ECG ( n = 5) Not reported Sheetal et al. (1998) Observational ( n = 100) India Mild ( n = 33) With warning signs ( n = 58) Severe ( n = 9) Sinus bradycardia ( n = 32) Not reported Kularatne et al. (2007) Cohort ( n = 120) Sri Lanka Mild ( n = 120) Patients with ECG changes such as T inversion, ST depression and bundle branch blocks ( n = 75). Of this group, 17 (23%) patients had hypotension and 58 (77%) developed tachycardia and bradycardia, suggestive of significant cardiac dysfunction Not reported Satarasinghe et al. (2007) Cohort ( n = 217) Sri Lanka Mild ( n = 217) Myocarditis ( n = 44); bradycardia ( n = 44) Not reported Da Costa et al. (2012) Case series ( n = 5) Brazil Mild ( n = 5) Ileo-femoral deep-vein thrombosis ( n = 2); pulmonary thromboembolism ( n = 2); mesenteric vein thrombosis ( = 1) None Guadalajara et al. (2014) Case report México Severe ( n = 1) Myocarditis characterised for: S3 gallop rhythm, generalised lung rales and shock; ECG showed sinus tachycardia, ST depression in V1–V3, and ST elevation in aVR and aVL. None Kularatne et al. (2018) Case series ( n = 3) Sri Lanka Severe ( n = 3) Tachycardia in three cases. Myocarditis confirmed by troponin estimation and echocardiogram in one case, and in the other two also was confirmed histopathology Type 2 diabetes ( n = 1) Bronchial asthma ( n = 1) Marques et al. (2013) Case reports ( n = 2) Singapore Severe ( n = 2) Myocarditis ( n = 2). ECG with widespread ST-segment eleva- tions and T-wave inversions and echocardiography with left ventricular systolic dysfunction with mild hypokinesia and an ejection fraction of 45% ( n = 1). Acute fatal myocarditis ( n = 1) Asthma ( n = 1) Bich et al. (2015) Case report ( n = 1) Vietnam Severe ( n = 1) Acute cardiac failure due to dengue myocarditis. ECG showed inverted T waves in the inferior leads, and troponin I was raised Hyperthyroidis Three miscarriages Naresh et al. (2008) Case report ( n = 1) New Delhi Severe ( n = 1) Myocarditis Not reported Chou et al. (2016) Case report ( n = 1) Taiwan Severe ( n = 1) Takotsubo cardiomyopathy. ECG showed sinus bradycardia, inverted T-wave changes (V3–V6), and prolonged QT interval (QTc = 597 ms). Elevated cardiac enzymes. Left ventriculo- graphy shows apical hypokinesia with preserved contractility at basal portion and left ventricular apical ballooning appearance Hypertension and diabetes Ramanathan et al. (2015) Case report ( n = 1) Singapore Severe ( n = 1) Dengue myopericarditis mimicking acute myocardial infarction. Hyperacute ST changes in the inferolateral leads. Echocardiogram with severe global left ventricular dysfunction with moderate pericardial effusion and no cardiac tamponade. The serum troponin I level elevated. None Tayeb et al. (2011) Case report ( n = 1) France Mild ( n = 1) Acute pericarditis. Consulting with acute chest pain. ECG revealed negative antero-lateral T waves with long QT segment Hypertension La-Orkhun et al. (2011) Prospective study ( n = 35) Thailand Mild ( n = 12) Moderate ( n = 18) Severe ( n = 5) Holter study in children. Sinus pause ( n = 1), first-degree ( n = 2) and Mobitz type I second-degree atrioventricular block (Wenckebach) ( n = 3) and atrial ( n = 4) and ventricular ectopic beats ( n = 5) Not reported Dhariwal et al. (2016) Case report ( n = 1) India Moderate ( n = 1) Repeated symptomatic episodes of high-degree atrioventricular block with ventricular asystole None Navinan et al. (2015) Case report ( n = 1) Sri Lanka Severe ( n = 1) Bradycardia with dynamic ECG changes, which evolved into complete heart block with atrioventricular dissociation and a junctional rhythm with a short P-R interval. None Sharda et al. (2013) Case series ( n = 8) India Not specified Sinus bradycardia ( n = 8). Echocardiography showed decreased ejection fraction (LVEF = 42%) ( n = 1) Not reported Khongphatthallayothin et al. (2000) Case reports ( n = 2) Thailand Severe ( n = 2) Morbitz type I second-degree atrioventricular block. Patient 1 also had occasional monomorphic premature ventricular contraction None Promphan et al. (2004) Case report ( n = 1) Thailand Severe ( n = 1) Myocarditis with bradycardia, showed a junctional rhythm with a rate of 50 beats/minute None Kaushik et al. (2010) Case report ( n = 1) India Severe ( n = 1) Sino-atrial block and atrioventricular dissociation None Mahmod et al. (2009) Case report ( n = 1) Malaysia Moderate ( n = 1) Atrial fibrillation None Horta Veloso et al. (2003) Case report ( n = 1) Brazil Moderate ( n = 1) Atrial fibrillation Diabetes mellitus