Cardiovascular change in children with dengue shock syndrome

Area of Science:

• Pediatrics
• Cardiology
• Infectious Diseases

Background:

• Dengue shock syndrome (DSS) is a severe manifestation of dengue infection.
• Cardiovascular compromise is a critical aspect of DSS, particularly in pediatric cases.
• Understanding these changes is vital for timely and effective management.

Purpose of the Study:

• To investigate the specific cardiovascular alterations in children diagnosed with dengue shock syndrome.
• To identify the hemodynamic parameters affected during DSS in pediatric patients.

Main Methods:

• Echocardiography was utilized to assess cardiac function and dimensions in 8 pediatric patients with DSS.
• Hemodynamic parameters including cardiac index, heart rate, stroke volume index, and systemic vascular resistance index were analyzed.
• Clinical data such as bleeding, hematocrit, platelet count, and organ function were correlated with cardiovascular findings.

Main Results:

• Patients presented with massive bleeding, thrombocytopenia, coagulopathy, and frequently developed acute renal and hepatic failure.
• Despite normal to low-normal cardiac dimensions, low stroke volume index and low systemic vascular resistance index were consistently observed.
• Left ventricular systolic function was preserved in most patients, even those requiring inotropic support, suggesting a primary issue with preload and vascular tone.

Conclusions:

• In pediatric dengue shock syndrome, reduced stroke volume and systemic vascular resistance are significant contributors to the shock state, beyond decreased preload from bleeding and third-spacing.
• These findings highlight the complex pathophysiology of DSS and the need to address both fluid deficits and vascular dynamics.