Supraventricular Tachycardia as an Uncommon Presentation of Dengue Myocarditis.

BACKGROUND

Dengue myocarditis has been increasingly reported, but supraventricular tachycardia (SVT) is a rare manifestation.

CASE SUMMARY: A 49-year-old woman presented to the emergency department with sudden-onset palpitations and lightheadedness. She was tachycardic but otherwise hemodynamically stable. An electrocardiogram demonstrated paroxysmal SVT. Laboratory tests demonstrated thrombocytopenia. Echocardiography showed preserved left ventricular systolic function (60%), with normal left ventricular chamber volumes. Cardiac biomarkers were negative. Given positive dengue NS1 antigen test, dengue myocarditis was suspected. The patient received intravenous fluids, diltiazem for rate control, and supportive care. The SVT resolved, and she was discharged.

DISCUSSION: In resource-constrained, endemic settings, this case emphasizes the need to identify SVT as a possible early presentation of dengue myocarditis and the need for guideline-directed arrhythmia therapy.

TAKE-HOME MESSAGE: Despite normal echocardiography, SVT in dengue-endemic areas should arouse suspicion for myocarditis, requiring early electrocardiography and guideline-based therapy.