Junctional Rhythm in a Child with Dengue Shock Syndrome

Dengue infection has become a serious health problem. It is endemic in most countries of the South-East Asian region. In hyperendemic regions, DHF is more common in children less than 15 years of age. There have been increasing reports of DF and DHF with atypical manifestations (Expanded dengue syndrome). The spectrum of cardiac involvement varies from conduction rhythm disturbances to myocarditis causing hypotension.
Arrhythmias are the first and early indicator of myocarditis. We report an 11-year-old girl who developed Junctional rhythm associated with dengue shock syndrome (DSS) from Mysore, India. Timely ECG will help the clinician detect cardiac involvement.
Even though cardiac involvement is rare in dengue fever, arrhythmias do occur. They are essential to diagnose, as they are the first signs of acute myocarditis. Arrhythmias with dengue shock may pose difficulties in the fluid management and use of inotropes. Simple ECG will help the clinician diagnose and monitor arrhythmias.