Cardiovascular change in children with dengue shock syndrome

Abstract

To determine the cardiovascular changes in children with dengue shock syndrome. Echocardiography was performed in 8 children (5 females) with dengue shock syndrome, median age 6.5, 4.2–13.7 yr and weight 34, 12–66 kg. All had massive bleeding with low initial hematocrit in most cases (median 31%), thrombocytopenia (median platelet 37,000/μL), and coagulopathy with massive pleural effusion. Seven (87.5%) developed acute renal failure and hepatic failure. All patients were in either compensate or decompensate shock with alteration of consciousness, tachycardia, poor tissue perfusion, and prolonged capillary refill (>4 s) with mean arterial pressure 65, 39–94 mm Hg. The cardiac dimension was normal to low normal except one had dilated left ventricle. Seven patients had normal left ventricular systolic function (5 with inotrope infusion). One patient had impaired systolic function even with inotrope. All had normal cardiac index (4.14, 3.51–6.37 L/min/m²) with increased heart rate (141.5, 110–160/min) but low stroke volume index (30.72, 25.37–42.49 mL/m²) and low systemic vascular resistance index (1,072, 223–2,880 dyne/sec/cm⁻⁵/m²). Decreased preload from bleeding and vascular leakage into the third space play an important role in shock in Dengue. However, decreased stroke volume and low systemic vascular resistance may be additional causes of shock.

Keywords

Dengue hemorrhagic fever - echocardiography - shock - hemodynamic - hemorrhage - pediatrics