WASHINGTON (FRONTLINE MEDICAL NEWS) – Patients infected with the Zika virus may have an increased risk of heart failure, arrhythmias, and myocarditis, according to a small study.

Observations were conducted of nine patients – six of whom were female with a mean age of 47 years – who were confirmed to have the Zika virus at the Institute of Tropical Medicine in Caracas, Venezuela, after displaying symptoms that included conjunctivitis, rash, and fever.

Patients were subjected to a multitude of tests, including virologic studies, echocardiogram, ECG, Holter monitoring, and cardiac MRI evaluations.

Of the nine patients observed by cardiologist and research fellow Karina Gonzales Carta, MD, of the Mayo Clinic, Rochester, Minn., and her colleagues, dangerous arrhythmias were found in eight, including three cases of atrial fibrillations, two cases of nonsustained atrial tachycardia, and two cases of ventricular arrhythmias.

Heart failure was detected in six of the nine patients; all but one patient had low ejection fractions.

“Our report provides clear evidence that there is a relationship between the Zika virus infection and cardiovascular complications,” Dr. Carta said during a media telebriefing held in advance of the annual meeting of the American College of Cardiology.

The patients studied did not show signs of “any previous known cardiac disease” and all developed symptoms within 2 weeks of infection, according to Dr. Carta.

The manifestation of these cardiac symptoms, coupled with the patients’ medical histories, led Dr. Carta and her research team to believe the symptoms were strongly associated with the Zika virus.

While researchers were not completely surprised by the higher rate of cardiovascular events, an observation that follows previously reported trends in similar mosquito-born viruses, such as dengue and chikungunya, Dr. Carta noted “the burden and severity of heart problems, including rapidly progressive heart failure and potentially life-threatening arrhythmias among these patients was unexpected.”

Given the small nature of the study, further testing is necessary to see the full extent of Zika’s effect on the cardiovascular system, as well as to raise awareness of the possible association.

“It’s likely that many more people are affected, especially because many clinicians and people may not make the connection between symptoms,” Dr. Carta said. “We need larger, systematic studies to understand the actual risk of Zika-related cardiac problems and what makes one patient more prone to develop them.”

In the meantime, Dr. Carta and her colleagues advise those living in or traveling to areas with high rates of Zika to be cautious, and they suggest that doctors test all patients diagnosed with Zika for signs of cardiac disease.


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