Cardiac complications and electrocardiographic changes observed during treatment with pentavalant antimony in visceral leishmaniasis [KALA-AZAR]

ABSTRACT

A total of 41 adult parasitologically proved hospitalized visceral leishmaniasis[Kala-azar] cases of both sexes were studied to see the cardiac complications and the electrocardiographic alterations during pentavalant antimonial [sodium stibogluconate] therapy in standard dose. The mean [ +/- SD] age and duration of fever of the patients were 26.2 [ +/- 10.6] years and 18.7 [ +/- 12.5] weeks respectively. All had normal ECG prior to therapy. Various electrocardiographic alteration were noted in 12 [29.3%] of the cases after starting antimony therapy. Out of them, one case manifested as a heart failure and another Strokes- Adams attacks, but both improved with conservative treatment. Electrocardiographic alterations noted were in the form of diffuse "T" inversion [8], sinus tachycardia [3] and conduction defect with diffuse 'T" inversion [1]. These changes were observed during third week of therapy and disappeared within two weeks of stoppage of further antimony therapy. Alterations in ECG might be the prior evidences of cardiotixicity and might explain sudden deaths encountered during antimony in kala-azar. These ECG alterations are usually asymptomatic, developing during the latter part of therapy and reversible. Close clinical observations and ECG monitoring of the patients receiving antimony therapy for kal-azar is essential for early detection of cardiotixicity and therapy to prevent complications including sudden death