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

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 5, September/October 2021 282 AFRICA In the case of lack of response to interventions based on fluid resuscitation, the presence of CV dysfunction should be considered, and inotropic support can be considered if appropriate. Medications with inotropic effect, such as dobutamine or levosimendan can be administered. The choice of drug should be based on knowledge of the history and particular clinical setting. Due to the lack of controlled clinical trials, no recommendation can be made on this topic. 14 The correction of abnormalities in serum potassium and calcium levels must be taken into account to reduce the appearance of arrhythmias, especially in the case of suspected myocarditis. 14 In cases of symptomatic bradyarrhythmia or complete heart block, it has been reported that the use of atropine and transient or permanent pacemakers have been effective in management. 23,24,30 Discussion Early detection of myocardial damage should be a main objective in patients with severe dengue, to prevent the development of multiple organ failure and death. The main limitation in achieving this objective is that the manifestation of CV consequences is subtle and can be confused with other diseases. Clinicians should be cognisant of atypical manifestations of CV involvement in dengue. 2,6,14 The low prevalence of CV disease due to dengue infection may result in a poor performance of most diagnostic tests. 14 Additionally, resources and availability may be limited in dengue- endemic countries. Application of imaging should be guided by clinical judgment and the findings of the physical examination. To date, there are no image-guided protocols for the diagnosis and tailored treatment of dengue. 2,14 Similar to other manifestations of dengue, myocardial damage is transitory and can resolve spontaneously in the first 48 hours after the onset of fever. However, in some cases they can complicate the clinical course of the disease and affect treatment decisions. In patients without response to fluid resuscitation, myocardial damage will mainly manifest with pump failure. Inotropes may be needed to control hypotension. 14 The role of heart rhythm disturbances in dengue outcomes is unknown. Factors that cause its appearance or aggravate its manifestations, such as electrolyte imbalance (hypocalcaemia for example) should be intentionally screened in hospitalised patients. Medications that prolong the QT interval should be avoided, such as amiodarone, chloroquine and quinolones. 14,24 Conclusions Dengue is a NTD that may have severe manifestations and cause seasonal outbreaks in endemic countries. Severe forms of dengue can progress to CV involvement. Detection of CV involvement through non-invasive imaging methods, such as echocardiography and CMR should be the objective in patients with severe forms of dengue, for diagnostic purposes, to inform treatment and to improve outcomes. References 1. Winkler AS, Klohe K, Schmidt V, et al. Neglected tropical diseases – the present and the future. Tidsskr Nor Laegeforen 2018; 138 (3): 10. 2. Guzman MG, Harris E. 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