Dengue Myocarditis Presenting as ST Segment Elevation MI

Area of Science:

• Cardiology
• Infectious Diseases
• Medical Education

Background:

• Dengue fever is a significant global health concern, primarily affecting tropical and subtropical regions.
• Myocarditis, inflammation of the heart muscle, is a rare but serious complication of dengue virus infection.
• ST-segment elevation myocardial infarction (STEMI) is a life-threatening condition characterized by blocked coronary arteries, typically treated with reperfusion therapy.

Observation:

• A case is presented where a patient exhibited symptoms strongly suggestive of STEMI, including characteristic electrocardiographic changes.
• Initial diagnostic evaluations and clinical presentation led to the administration of thrombolytic therapy, a treatment for STEMI.
• Subsequent investigations revealed that the patient's cardiac symptoms were actually caused by dengue myocarditis, not a coronary event.

Findings:

• Dengue myocarditis can present with electrocardiographic findings that closely resemble those of an ST-segment elevation myocardial infarction.
• The clinical presentation and initial diagnostic markers of dengue myocarditis may be misleading, potentially leading to misdiagnosis.
• Thrombolysis, when administered for presumed STEMI due to dengue myocarditis, carries risks without addressing the underlying viral etiology.

Implications:

• Heightened clinical suspicion for dengue myocarditis is essential in endemic areas, especially during dengue outbreaks.
• Distinguishing dengue myocarditis from STEMI requires a comprehensive diagnostic approach, potentially including specific viral markers and cardiac imaging.
• Avoiding unnecessary and potentially harmful treatments like thrombolysis in cases of dengue myocarditis can improve patient outcomes and reduce healthcare costs.