Electrocardiographic changes in patients with haemorrhagic fever with renal syndrome

Abstract

The purpose of the study was to assess the incidence, type and dynamics of electrocardiography (ECG) alterations in patients with haemorrhagic fever with renal syndrome (HFRS) according to different stages of the disease. 79 patients hospitalized at the University Hospital for Infectious Diseases in Zagreb during the large HFRS outbreak in Croatia in 2002 were retrospectively analysed. HFRS diagnosis was confirmed by enzyme-linked immunosorbent assay. A 12-lead resting ECG was obtained. 30 (38%) patients had abnormal ECG findings, most frequently in the oliguric stage. Increased levels of urea and creatinine were observed in all patients with abnormal ECG, along with abnormal chest X-ray in nearly 50% of cases. Sinus tachycardia was the most frequent ECG disorder in the febrile stage, and bradycardia in the oliguric stage. During the course of disease, some other ECG disorders were recorded: bundle branch conduction defects, non-specific ventricular repolarization disturbances, supraventricular and ventricular extrasystoles, prolonged QT interval, low voltage of the QRS complexes in standard limb leads, atrioventricular block first-degree, and atrial fibrillation. Myocarditis was present in 3 patients. In conclusion, abnormal ECG was found in more than one-third of HFRS patients with the most common findings during the oliguric stage. All ECG changes were transient.

Time to revise the paradigm of hantavirus syndromes? Hantavirus pulmonary syndrome caused by European hantavirus

“…Previously, respiratory symptoms were commonly attributed to fluid overload as a result of renal failure. However, increasing evidence show that lung and heart involvement is common during the acute phase of HFRS [10, 11, 22, 23]. Concerning the cases of European hantavirus infection in our present report, there was only mild or no renal impairment at the time of admission, whereas the respiratory involvement was early and severe, consistent with acute respiratory distress syndrome (ARDS), fulfilling criteria of HPS according to CDC case definition [19].…”

Puumala Virus Infections Associated with Cardiovascular Causes of Death

“…Moreover, >25% of HFRS patients in Sweden had evidence of disseminated intravascular coagulation, which correlated with HFRS disease severity (14). Taken together, data from these studies (6,10–15) and the present data indicate a possible association between PUUV infection and precipitation of CVD events that could eventually lead to death.…”

“…The elevated risk is more pronounced during the acute phase of respiratory viral infection but can still be increased 3 months afterwards (9). Abnormal electrocardiograms (10,11) and myocarditis (12) have been observed during the acute phase of PUUV infection, indicating an association between PUUV infection and cardiovascular disorders. Furthermore, PUUV antigen has been found in cardiac tissue (6), and other studies have documented the essential role of coagulopathy in HFRS disease severity (13–15).…”

Experience with Extrarenal Manifestations of Hemorrhagic Fever with Renal Syndrome in a Tertiary Care Hospital in South Korea

“…These findings resolved spontaneously as the patients recovered, consistent with a previous report. 19 Puljiz and others reported that all ECG alterations were transient and all patients, including three with myocarditis, recovered spontaneously. However, in our case series, two of four patients with cardiac manifestations, one with myocarditis and one with pericarditis, died during the oliguric phase.…”