Complete atrioventricular block-an uncommon clinical presentation in an adult patient with proven dengue fever.

Dengue is a viral disease that clinically presents with fever, thrombocytopenia-related haemorrhagic complications and shock in its severest form. This female patient in her 40s primarily presented to the emergency department of the cardiac centre as syncopal attacks with a complete atrioventricular block. Temporary cardiac pacing as an emergency procedure helped to maintain cardiac rhythm and haemodynamics. A history of recent onset fever helped us to suspect and confirmed by serology for dengue pathology. Normal sinus rhythm was restored after 2 days, and we removed the temporary pacing. Cardiac arrhythmia did not recur in 6 months of follow-up. The aetiology for dengue-related cardiac arrhythmia is still not established. In the recovery phase from fever, complete heart block may show up as a primary presentation in the emergency. Its timely diagnosis and temporary pacing may allow spontaneous recovery. The inclusion of electrocardiography in dengue patient guidelines should help clinicians to dictate its treatment.

Pulse Oximetry Waveform Represents an Earlier Ventricular Contraction in Relation to the Intraarterial Blood Pressure Tracing and Electrocardiogram on Multichannel Monitors: A Case Series.

Multichannel patient monitors apparently display the electrocardiogram, intra-arterial blood pressure, and pulse oximetry waveforms in synchrony during sinus cardiac rhythm. We recorded 20 events of a premature cardiac contraction on multichannel monitors from 10 patients. Interestingly, during premature cardiac contraction, the low-amplitude arterial trace was aligned with the premature electrocardiogram, but the low-amplitude pulse oximetry plethysmograph was aligned with the next normal electrocardiogram and arterial tracing. In conclusion, the pulse oximetry plethysmograph tracing is offset by 1 ventricular depolarization on the electrocardiogram (QRS) and the arterial tracing on multichannel monitors.

Asynchrony Between Ventilator Flow and Pressure Waveforms and the Capnograph on Dräger Anesthesia Workstations: A Case Report.

Modern anesthesia workstations display capnography, flow-time, and pressure-time waveforms in real time. We observed that at certain ventilator settings (10 breaths/min) on Dräger workstations, the expiratory phase of the capnograph overlaps both the inspiratory and the expiratory phases of ventilation. This discrepancy disappears at respiratory rates of 16 breaths/min. This synchronous respiratory monitoring display at respiratory rates 16 breaths/min is not physiologically correct, because it implies a synchronization of waveforms that is not actually present. This again becomes asynchronous once the respiratory rate is increased to >18 breaths/min. Such an artifact may not affect the patient's safety in most cases but may mislead clinicians when synchrony between flow/pressure and capnography is needed for diagnostic purposes. We wish to share this discrepancy with clinicians and notify the manufacturer so that potential solutions may be found.