European Journal of Molecular & Clinical Medicine ISSN 2515-8260 Volume 07, Issue 08, 2020 149 Changes of Electrocardiography Based on Disease Severity in Dengue Hemorraghic Fever Ivan Tanawal 1 , Idar Mappangara 2 , Sudirman Katu 3 , Syakib Bakri 4 , Haerani Rasyid 5 , Pendrik Tandean 6 , Risna Halim 7 , Hasyim Kasim 8 , Arifin Seweng 9 1,2,3,4,5,6,7,8 Department of Internal Medicine, Medical Faculty, Universitas Hasanuddin, Makassar 90245, Indonesia 9 Department of Biostatistics, Public Health Faculty, Universitas Hasannddin, Makassar 90245, Indonesia E-mail: ivantanawal@gmail.com Dengue virus (DENV) infection is a global health threat affecting at least 3.6 billion people living in more than 125 countries in the tropics and subtropics. 1 Dengue hemorrhagic fever(DHF) is one of the public health problems in Indonesia that increasingly widespread. 2 In 2018, the total incidence of dengue fever in Indonesia were 65,602 cases, with 467 deaths. The DHF morbidity rate in 2018 decreased compared to 2017, from 26.10 to 24.75 per 100,000 population. The morbidity rate in South Sulawesi Province, Indonesia, was 24.1 per 100 000 population, and the case fatality rate was 0.9%. 2 Dengue fever (DF) and DHF are infectious diseases caused by the dengue virus, which belongs to the flavivirus genus, the flaviviridae family. The disease can present as a mild self-limiting illness, DF, or as the more severe forms of the disease, DHF and dengue shock syndrome (DSS). All four dengue virus serotypes (DENV-1, DENV-2, DENV-3 and DENV-4) can cause dengue. Clinical manifestation of severe dengue includes severe bleeding, severe organ involvement and severe plasma leakage. 1 Cardiovascular involvement is usually found in dengue infection. 3 Spectrum of cardiovascular manifestation include asymptomatic patient with electrocardigram (ECG) abnormality up to myocarditis and cardiogenic shock which are life threatening condition. 4,5 These phenomenons are frequently reversible, as proper treatment is performed for dengue infection. But some cases need specific consideration which may cause worse condition if left untreated. 4,6,7 We have experienced one case with reversible abnormal ECG in DHF. Patient had DHF Grade 2 with disseminated intravascular coagulation (DIC) and AV block grade II type 1 in initial ECG. Patient had no history of syncope or dizziness related to her AV block. We performed serial ECG to observe her AV block. During her hospital stay, she had shock episode and treated by fluid rescucitation until she became in stable condition. Day by day along with her DHF treatment simultaneously, she had spontaneous AV block resolution. Spontaneous AV block resolution has been reported also by other study after DHF symptoms was relieved. 8 Based on this finding, we were look for other abnormal ECG in dengue infection and how dengue infection affects cardiovascular structure and function.