Zika Virus May Be Linked to Cardiovascular Complications

New evidence suggests the Zika virus may have detrimental effects on the heart.

The study is the first to report a link between the virus and heart problems following infection. Included in the study were adults with no prior history of cardiovascular disease who were treated at the Institute of Tropical Medicine in Caracas, Venezuela—one of the epicenters of the Zika virus outbreak.

The results of the study showed that all but 1 patient developed a dangerous heart rhythm condition and two-thirds had evidence ofheart failure.

“Our report provides clear evidence that there is a relationship between the Zika virus infection and cardiovascular complications,” said lead author Karina Gonzalez Carta, MD. “Based on these initial results, people need to be aware that if they travel to or live in a place with known Zika virus and develop a rash, fever, or conjunctivitis, and within a short timeframe also feel other symptoms such as fatigue, shortness of breath, or their heart skipping beats, they should see a doctor.”

Although the investigators were not entirely surprised by their findings, the burden and severity of heart problems—–including rapidly progressive heart failure and arrhythmias––among the patients was unexpected.

Included in the small, prospective case report were 9 patients seen in the Caracas clinic within one week of experiencing Zika-type symptoms and who subsequently reported common symptoms of heart problems. Six of 9 patients were female, and all the participants were followed for an average of 6 months, beginning in July 2016.

Lab tests confirmed that all participants had active Zika infection, and only 1 patient had a prior cardiovascular problem (well-controlled high blood pressure).

The patients were required to fill out a form recording their symptoms, and they had to undergo an initial electrocardiogram. Of these, 8 cases were suggestive of an issue with the rate or rhythm of the patient’s heartbeat.

The investigators performed a full cardiovascular work-up using an echocardiogram, a 24-hour Holter monitor, and a cardiac magnetic resonance imaging study.

The results of the study detected arrhythmias in 8 of 9 patients: 3 cases of atrial fibrillation, 2 cases of nonsustained atrial tachycardia, and 2 cases of ventricular arrhythmias.

Heart failure was detected in 6 cases, of whom, 5 patients had heart failure with low ejection fraction and 1 had heart failure with preserved ejection fraction along with preeclampsia and moderate to severe pericardial effusion.

To date, none of the patients’ cardiac issues have been resolved, but the symptoms have improved due to guideline-directed treatment for heart failure or atrial fibrillation.

The authors noted that there was an average lag time of 10 days from the patients’ initial complaints of Zika symptoms to reports of symptoms that suggest heart problems.

“Since the majority of people with Zika virus infections present with mild or non-specific symptoms and symptoms of cardiovascular complications may not occur right away, we need to raise awareness about the possible association,” Carta said.

Although cardiovascular manifestations are fairly rare against the total number of patients treated at the clinic, the authors believe more cases will be diagnosed.

“It’s likely that many more people are affected, especially as many clinicians and people may not make the connection between symptoms,” Carta said. “We need larger, systematic studies to understand the actual risk of Zika-related cardiac problems and what makes one patient more prone to develop them.”

The findings will be presented at the American College of Cardiology’s 66th Annual Scientific Session in Washington, DC.