title: Malaria and the heart.
abstract: A 40-year-old healthy manual labourer from a malaria endemic area with no known risk factors for atherosclerotic coronary vascular disease was admitted to our hospital with a history of fever with chills and rigours. Physical examination revealed tachypnoea and icterus. Peripheral smear showed trophozoites of Plasmodium vivax and thrombocytopaenia. The patient was administered artesunate. Six hours after admission, he complained of severe substernal chest pain. A 12-lead ECG revealed ST elevations in leads I, II and aVL. Troponin T and creatine kinase MB were elevated and the random blood sugar was 49 mg%. Echocardiogram revealed left ventricle lateral wall hypokinesia. Hypoglycaemia was corrected. A provisional diagnosis of acute coronary syndrome as a complication of malaria or its treatment was made. He was treated with low molecular weight heparin and nitrates. The patient improved symptomatically. A repeat ECG was normal.
authors.affiliation: Department of Medicine, Father Muller Medical College, Mangalore, Karnataka, India. doctorsmitha@yahoo.co.in
authors.forename: Smitha
authors.initials: S
authors.lastname: Bhat
authors.forename: Jayaprakash
authors.initials: J
authors.lastname: Alva
authors.forename: Krithika
authors.initials: K
authors.lastname: Muralidhara
authors.forename: Sayid
authors.initials: S
authors.lastname: Fahad
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology*; D000328:Adult; D000962:Antimalarials / Q000009:adverse effects / Q000627:therapeutic use; D037621:Artemisinins / Q000009:adverse effects / Q000627:therapeutic use; D000077332:Artesunate; D004359:Drug Therapy, Combination; D004562:Electrocardiography / Q000187:drug effects; D019353:Endemic Diseases; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D016780:Malaria, Vivax / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D009566:Nitrates / Q000627:therapeutic use; D013921:Thrombocytopenia / Q000175:diagnosis
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D006495:Heparin, Low-Molecular-Weight; D009566:Nitrates; D000077332:Artesunate