World Malaria Day 2023: Can Malaria affect your heart and cause heart failure? What experts say

World Malaria Day 2023: Malaria may directly or indirectly affect heart and cause heart failure. However, this complication is rare.

Malaria is a disease caused by a plasmodium parasite, which is spread to people by the bite of infected female Anopheles mosquitoes. The symptoms of Malaria can be mild as well as severe. The mild ones include fever, chills and headache while fatigue, confusion, seizures and difficulty in breathing are among the severe ones. While the initial signs are usually mild, not treating it can lead to its progression to severe illness and death within 24 hours. (Also read: Indian scientists successfully conduct animal trial of drug for malaria)

Malaria is a protozoan disease which spreads by the bite of infected female anopheles mosquitoes. (Pixabay)

World Malaria Day is celebrated annually on April 25 to spread awareness about this disease, bring together the global malaria community to highlight global efforts to end the disease, the need for sustained political commitment and continued investment for malaria control and its elimination. This year, the theme for World Malaria Day is - “Time to deliver zero malaria: invest, innovate, implement”.

"Malaria is a protozoan disease which spreads by the bite of infected female anopheles mosquitoes. It is the most important parasitic disease of humans. There are six species of genus plasmodium that cause nearly all malarial infections in humans. Almost all deaths occur due to falciparum malaria. Severe falciparum malaria may lead to multiple complications like cerebral malaria (malarial encephalopathy), seizures, hypoglycaemia (low blood sugars), coma, severe anaemia (very low haemoglobin), renal failure, pulmonary edema or ARDS, shock, sepsis, bleeding due to low platelets and coagulopathy and liver dysfunction," says Dr Santosh Kumar Agrawal, Senior Consultant, Internal Medicine, Marengo Asia Hospitals Faridabad.

Malaria can also have an impact on kidneys, liver and even lead to anaemia leading to life threatening consequences. Another rare complication of Malaria is its direct or indirect effect on heart which may also cause heart failure.

"The involvement of heart in malaria is a rare complication of malaria but has been reported on several occasions in the medical literature. Cardiac involvement has not been included as a frequent cause of mortality and morbidity following malaria. This could be attributed to under-reporting or underdiagnosing. The cardiovascular manifestations associated with malaria include electrocardiogram (ECG) abnormalities, myocarditis, pericarditis, pericardial effusion, ischemic disease, arrythmias, conduction disorders, and heart failure. These manifestations can lead to severe consequences," says

Dr Monalisa Sahu, Consultant Infectious Diseases, Yashoda Hospitals Hyderabad.

"According to a study presented at ESC congress 2019 with world congress of cardiology, Malaria may impact the blood pressure regulatory system that may lead to hypertension. Hypertension is a great risk factor for heart failure. Hence Malaria may also affect vascular pathways that may lead to inflammation in the heart causing fibrosis and then heart failure. If someone experiences symptoms such as high-grade fever, chills, headache, nausea, vomiting, muscle pain and fatigue, he/she should immediately seek medical advice. If symptoms are left unnoticed, these may get worse and cause serious health complications," says Dr Agrawal.

How Malaria directly or indirectly contributes to heart failure

"The most common risk factors for heart failure include a combination of high blood pressure, diabetes, obesity, and coronary artery disease. Malaria may directly as well as indirectly contribute to affecting the heart and heart failure. The possible mechanisms by which these manifestations and cardiovascular compromise may occur include an imbalance in the pro-inflammatory cytokine response; and red blood cell sequestration in the blood vessels and adherence of the red blood cells to the interior of the blood vessels (endothelium). This increased adherence may lead to impairment of the microcirculation and thus lactic acidosis and occasionally heart failure. Malaria may also cause the blood pressure regulatory system to be affected leading to hypertension, which can further contribute to heart failure," says Dr Sahu.

"Malaria may also affect vascular pathways that cause inflammation in the heart, which could lead to fibrosis and then heart failure. Complicated malaria can cause acute renal failure, which may lead to anaemia related to kidney disease, which may lead to altered hemodynamic fluid state, leading to cardiac stress and thus heart failure," adds Dr Sahu.

"Involvement of the heart muscles, myocarditis, which usually presents as chest pain, heart failure and sometimes cardiogenic shock is the most common cardiac complication of malaria. It is more commonly reported with Plasmodium falciparum malaria. ECG, cardiac biomarkers, 2D Echo may be sent in cases of complicated malaria for early detection of cardiovascular manifestations of malaria and for timely intervention to have a favourable outcome," says Dr Sahu explaining the other cardiac complications of Malaria.

Precautionary measures to keep Malaria at bay

Dr Agarwal shares measures to avoid getting infected by Malaria and avoiding its many complications.

· Maintaining hygiene at home is the key to prevent malaria. Home should be mopped with disinfectant daily.

· To keep mosquito bites at check, put on light-coloured full sleeves or legs clothes that cover most of your body.

· Don’t let the mosquitoes enter home by keeping doors and windows shut specially at evening.

· Keep your immune system strong with consumption of a balanced diet that may fight infection.

· To avoid exposure to mosquitoes, you should use repellents, creams, sprays and insecticide-treated nets.

· If someone is allergic to chemicals found in mosquito repellents, he/she may go for natural remedies. Garlic and rosemary contain mosquito larvicidal properties. You may prepare your own natural mosquito repellent spray by boiling crushed garlic clove. Fill the solution in a spray bottle and apply it to stop mosquito bites.

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