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Giant biphasic T wave electrocardiogram pattern (Z syndrome) in patient with Plasmodium Vivax malaria infection

Author : P.R. Kusuma, E. Zuhri
Upload Date : 19-04-2018

Background: Malaria was a unique disease where many organ might be affected simultaneously or sequentially. Several studies showed that malaria infection could affect cardiovascular system, especially in electrocardiogram pattern. Here, we presented a case report of patient with giant biphasic T wave electrocardiogram pattern (Z syndrome) in plasmodium vivax infection.

Case Report: Mr. R, 41 years old, non-obese man came to emergency room (ER) department with chief complaint fever with chill since 3 days ago, patient’s fever was felt during a day and night, patient also complaint headache with nauseas but no vomiting, felt pain in all of his joint, no chest pain or shortness of breathing. Patient was smoker 12 stick per day, no dyslipidemia, no hypertension or diabetes mellitus, no cardiac disease before, and no history of cardiac disease in his family. At the time in a on arrival at ER, the hemodynamic was stable, with the body’s temperature was 38.10C. The other physical examination were in normal limit. The ECG examination revealed giant biphasic U wave at lead II, III, AVF and V2-6 (figure 1). The blood smear examination revealed plasmodium vivax infection. The peripheral blood examination was in normal limit, except thrombocyte was 51.000 /uL. Blood electrolyte, blood glucose, lipid profile, cardiac enzyme, renal function, hepatic function, chest x-ray, and previous echocardiogram was in normal limit. Patient was treated with dihydroartemisinin-piperaquine, primaquine, paracetamol, esomeprazole, and ringer lactate infusion.

Discussion: The exact mechanism of electrocardiogram pattern changes was unknown. A biphasic T wave might represent cardiac ischemia and might be related with microvascular obstruction because of parasite sequestration.

KEYWORDS : Giant biphasic T wave, Plasmodium Vivax, Malaria Infection, Z syndrome


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