Dengue fever complicated with acute ST elevation myocardial infarction - a therapeutic conundrum: our experience from two cases

Abstract

Dengue fever has a wide range of clinical manifestations from asymptomatic disease to complicated dengue haemorrhagic fever and dengue shock syndrome. Bleeding manifestations in dengue is well known but thrombotic events complicating dengue is uncommon. ST elevation myocardial infarction during dengue is rare and poses important management dilemma. At present, there is no consensus on how to manage this situation. We present two patients with dengue fever developing ST elevation myocardial infarction and our experience in the management. We suggest case-based management of acute coronary syndrome in dengue, guided by the degree of thrombocytopaenia and bleeding risk. Further studies are needed to include this into existing dengue management guidelines.

Dengue fever complicated with ST elevation myocardial infarction with atypical features: A case report

“…However, there is limited literature regarding myocardial infarction complicating dengue fever, mostly in the form of case reports. Wijayabandara et al 4 had presented two cases of dengue fever complicated with acute STEMI. Both of those cases were managed conservatively.…”

“… 3 Dengue has been known to cause cardiovascular complications, reported in up to 12.5% patients with severe dengue, in the forms of conduction abnormalities, hypotension, arrhythmias, myocarditis, pericarditis or cardiomyopathy. 3 , 4 In this report, we describe a case of 58-year-old female patient with ST-elevation myocardial infarction (STEMI) complicating dengue fever who had presented to a tertiary care center in Nepal.…”

Spontaneous coronary hematoma concomitant with myocarditis: the first report of double cardiac complication of dengue

“…Two cases of ST‐segment elevation myocardial infarction in acute phase of dengue fever were reported by Wijayabandara et al ., but none of them had a coronary angiography. 8 …”

“…Two cases of ST-segment elevation myocardial infarction in acute phase of dengue fever were reported by Wijayabandara et al, but none of them had a coronary angiography. 8 Shih-Ching Lin et al presented the original case of simultaneous multivessel ST-segment elevation myocardial infarction with double thrombotic occlusion, in a context of dengue fever. 5 Spontaneous coronary artery dissection is a rare cause of coronary artery syndrome (1.7% of all cases 9 ), preferentially occurring in young women without cardiovascular risk factors.…”

“…A case of suspected coronary artery spasm was reported in a context of dengue haemorrhagic fever 7 although differential diagnoses (acute myocarditis, coronary artery obstruction) had not been excluded, as cardiac MRI and coronary angiography could not be performed. Two cases of ST‐segment elevation myocardial infarction in acute phase of dengue fever were reported by Wijayabandara et al ., but none of them had a coronary angiography 8 …”