ELECTROCARDIOGRAPHIC MONITORING IN SEVERE FALCIPARUM-MALARIA

Electrocardiographic monitoring over 24 h was performed with 53 patien ts with severe Plasmodium falciparum malaria (11 adults and 42 childre n) to assess the frequency of unrecognized cardiac arrhythmias. Nine p atients (17%) died, 5 during the monitoring period and 4 afterwards. P auses lasting 2-3 s were observed in 3 children, a single coupler in o ne, and a further child experienced frequent supraventricular ectopic beats which had nor been detected clinically. In none of the patients who died could death be attributed to cardiac arrhythmia. Furthermore, no abnormality was detected which could have resulted from the often large doses of quinine, chloroquine or the artemisinin derivatives use d for treatment. These results suggest that the heart is remarkably re silient even in the face of heavy parasite sequestration and other vir al organ dysfunction, and that deaths from cardiac arrhythmias in seve re malaria are rare. The need for routine cardiac monitoring of patien ts with severe and complicated P. falciparum malaria is questionable.