Carditis in Zika Virus Infection

We describe an interesting case of a 52 year-old patient affected by thyrotoxicosis crisis, in whom sinoatrial blocks were associated with syncope and treated efficiently with beta-blockers.

We hypothesized the Bezold-Jarisch reflex as the mechanism which leads to bradycardia and hypotension with syncope related to prolonged tachycardia.

This hypothesis has not been, to our knowledge, considered in previous studies and offers therapeutic methods, as the patient was not treated with permanent pacing.

Dear Editor, the Zika virus infection becomes a big global problem at present. The clinical manifestation of this infection can be from asymptomatic to severe acute febrile illness with hemorrhagic complication. Focusing on cardiovascular effect, there are some reports on the problem. Recently, the problem of carditis due to Zika virus infection becomes a big concern in cardiology. The report by Aletti et al. [1], on transient myocarditis leads to the great concern by the cardiologist. Aletti et al. [1], noted that “We recommend an electrocardiogram and an troponin if any cardiac symptoms are present in a patient with acute Zika infection.” Indeed, based on the nanostructural consideration of Zika virus and the similar pathology and pathogenesis between Zika virus and dengue infections, the cardiovascular problem due to Zika virus infection can be expected [2]. How Zika virus affects heart and what kind of mechanisms are the interesting questions in cardiology. There are many proposed mechanisms. The Zika virus might directly attach heart tissue or there might be some immunopathological process. The direct cardiac involvement or cardiopathy as a consequence of immunopathology or non-immunopathology in the course of Zika virus infection is an interesting issue for further research in cardiology.

1. Aletti M, Lecoules S, Kanczuga V, Soler C, Maquart M, et al. (2016) Transient myocarditis associated with acute Zika virus infection. Clin Infect Dis. Link: https://goo.gl/UHt8gF
2. Joob B, Wiwanitkit V (2016) Cardiac problem because of Zika virus infection: a possibility. Anatol J Cardiol. 16: 455-456. Link: https://goo.gl/zqm4QK