Rabies in coronary care unit: a case report

Abstract

Rabies features encephalitis and neurological symptoms. Although its clinical course can be prolonged by life support measures, its fatal outcome is virtually inevitable. Coronary artery disease has become so common that anyone complaining of chest discomfort is suspected. Despite the fact that rabies encephalitis is often complicated with heart impairment or myocarditis, it can still be ignored when cardiac symptoms like chest discomfort or shortness of breath act as chief complaints. This case report demonstrates a rabies patient presenting with conditions similar to acute coronary syndrome; he even underwent coronary angiography. He was the only rabies patient admitted by cardiologists in our hospital. This case reminded us that some unusual cause of cardiac manifestations needs to be considered during daily management of chest discomfort.

Unusual Chief Complaint of Patient with History of Vaccination Leading to Unrecognized Human Rabies with Extreme Risk of Saliva Exposure for Medical Personnel-A Case Report and Literature Review

“…Especially in the case presented here, the chief complaint of chest pain deviated the medical team's attention/focus away from a diagnosis of rabies to heart disease. Though uncommon, such cases have been reported ( Table 2) [4][5][6][7][8] , since rabies can caused focal interstitial myocarditis as discussed by Park et al 9 In the case series reported by Mani et al 10 , all cases presented without evidence of chest pain, so the clinical presentations of rabies vary. Furthermore, concerning the classical sign of fear of water, in our case, the patient 11 In terms of the forensics aspect, since a rabies investigation is not performed on every case with an unknown cause of death examined by only external examination, the forensic physician thought of rabies infection as the cause of death based on the review of the history recorded on the first emergency room visit and the numerous dogs observed by the forensic physician at the crime scene during the post-mortem visit at the patients residence.…”

Rabies and the Heart

“…The patient presented with shortness of breath and upper limb paresthesias; the electrogram showed persistent ST-segment elevation, autonomic instability with Mobitz type II atrioventricular block, asystole, and a forthright elevation of cardiac biomarkers [ 15 ]. Typical symptoms of myocarditis such as chest pain, hypotension, and signs of heart failure have been reported [ 14 - 18 , 26 ]. Boukas et al reported a case where an echocardiogram showed progressive dilatation, increased thickness, and irregularities of the coronary arteries suggesting a vasculitis process [ 27 ].…”