Sir,
Malaria has been a long-standing disease, especially for tropical countries like India. It is a multisystem disorder affecting almost every system of the body, including the cardiovascular system. Although rare, severe malaria can cause cardiovascular complications such as circulatory failure, tachycardia, bradycardia, myocarditis, and pericardial effusion. A 23-year-old female presented with fever with chills and rigors for 5 days, severe headache, respiratory distress, yellowish discoloration of eyes, and urine for 2 days. Her vitals were blood pressure-84/60 mmHg, pulse 40/min, SPO2-94%, respiratory rate 24/min, random blood sugar-104 mg/dl, temperature-102.4oF. Electrocardiogram (ECG) showed sinus bradycardia with a heart rate of 39/min [Figure 1]. Laboratory investigation showed hemoglobin-7.2 g%, total leukocyte count -15600 cells/μl, serum bilirubin total/direct/indirect-5.4/1.8/3.6 mg/dl, urea-84 mg/dl, creatinine-2.46 mg/dl. Peripheral blood smear showed an asexual stage of Plasmodium vivax, and the diagnosis was confirmed by polymerase chain reaction for P. vivax. We ruled out other causes of bradycardia such as drugs, hypothyroidism, and dyselectrolytemia. Two-dimensional ECHO was unremarkable. She was treated with IV artesunate, and after 4 days, her heart rate became normal (70/min).
Figure 1.
Electrocardiogram of the patient showing sinus bradycardia
Cardiovascular complications in malaria occur due to imbalanced pro-inflammatory cytokine response, endothelial dysfunction, and sequestration of infected RBCs in cardiac capillaries, leading to ischemic injury. In addition, some antimalarial drugs, for example, quinidine and mefloquine, cause QTc prolongation and bradycardia.[1,2,3]
A prospective study conducted by Nayak et al. in 2013, concluded that vivax malaria is no more benign and can involve the cardiovascular system as evidenced by ECG changes.[4] A prospective study conducted by Ray et al. in 2017 concluded that both falciparum and vivax malaria can lead to cardiovascular complications.[5]
Research quality and ethics statement
The authors followed applicable EQUATOR Network (https://www.equator-network.org/) guidelines, notably the CARE guideline, during the conduct of this report.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
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