Cardiac involvement in malaria: an overlooked important complication.

organs may be affected simultaneously or sequentially. It is still an enigma why one, or more or even none of the organ is affected. It is also not clear yet, when and which organ will be failing. Even persons from one geographical area may have different presentations. There are a lot of heterogeneity and unpredictable consequences. World Health Organization1 has outlined the criteria for severe malaria depending upon the available data, mostly from Africa. While severe anaemia, cerebral malaria1–4, acute kidney injury5–6, multiple seizures, acute lung injury, circulatory collapse, etc. are included, several other complications are still important, viz. jaundice or hepatic involvement7–8, black water fever or haemoglobinuria, rhabdomyolysis9, acral gangrene, etc. However, only a few studies have been carried out regarding the cardiac function in severe malaria10–12. In this article, we attempt to review briefly the published data on cardiac involvement of malaria. It may stimulate the clinicians to ponder over for future studies. Hypotension, shock and circulatory collapse with impaired hemodynamic function have been observed in severe malaria patients1. Though it occurs occasionally in the severe malaria cases and it occurs frequently in sepsis. The role of the heart in severe malaria has not received due attention. In 2004 and 2005, Ehrhardt et al13–14 have demonstrated raised cardiac enzymes in complicated malaria. Similarly, Yacoub et al15 assessed ejection fraction by echocardiography which significantly reduced on admission compared with discharge.