Cardiac Involvement in a Pediatric Patient with COVID-19: Looking Beyond the Nonspecific Global Cardiac Injury

Bhansali, Suneet; Minocha, Prashant; Phoon, Colin K.L.; Henry, Gillian; Chakravarti, Sujata; Ramírez, Michelle; Bhatla, Puneet

doi:10.22541/au.159007761.13746208

Cited by 3 publications

(3 citation statements)

References 8 publications

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“…Case reports and small series have described cardiogenic shock, myocarditis, pericarditis, and arrhythmias. 67–70 Arrhythmias have included ventricular tachycardia and atrial tachycardia, as well as first-degree atrioventricular block. 15,71 Although arrhythmias are generally nonsustained and self-resolve without need for treatment, prophylactic antiarrhythmics have been administered in some cases, 15 and death caused by recurrent ventricular tachycardia in an adolescent with hypertrophic cardiomyopathy has been described.…”

Section: Clinical Presentationmentioning

confidence: 99%

SARS-CoV-2 Infection and Associated Cardiovascular Manifestations and Complications in Children and Young Adults: A Scientific Statement From the American Heart Association

Jone¹,

John²,

Oster³

et al. 2022

Circulation

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Coronavirus disease 2019 (COVID-19) resulted in a global pandemic and has overwhelmed health care systems worldwide. In this scientific statement, we describe the epidemiology, pathophysiology, clinical presentations, treatment, and outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and multisystem inflammatory syndrome in children and young adults with a focus on cardiovascular manifestations and complications. We review current knowledge about the health consequences of this illness in children and young adults with congenital and acquired heart disease, the public health burden and health disparities of this infection in these populations, and vaccine-associated myocarditis.

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Section: Clinical Presentationmentioning

confidence: 99%

SARS-CoV-2 Infection and Associated Cardiovascular Manifestations and Complications in Children and Young Adults: A Scientific Statement From the American Heart Association

Jone¹,

John²,

Oster³

et al. 2022

Circulation

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“…In a young patient with shock state due to COVID-19, diminished LVEF of 40% and regional hypokinesia were confirmed by CMRI demonstrating global biventricular systolic dysfunction, as well as a small area of T2 hyperintensity and mid-wall LGE [12]. In another study investigating athletes with a history of COVID-19, it was reported that 9% had LGE in CMRI.…”

Section: Discussionmentioning

confidence: 91%

Cardiac Magnetic Resonance Imaging in Patients with COVID-19

Erenler¹,

Komut²,

Baydın³

2020

RDI

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In the beginning of December 2019, an outbreak of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was determined in Wuhan, Hubei, China. Besides its predominant respiratory system-related symptoms, cardiovascular involvement has also been described in adults with direct and indirect cardiac injury. Pre-existing cardiovascular disease and cardiac risk factors have been shown to increase the risk of cardiac complications of COVID-19 infection. However, it is also known that healthy and asymptomatic COVID-19 survivors suffer cardiac damage-related complications. Cardiac Magnetic Resonance Imaging (CMRI) is known to be the reference non-invasive standard to present cardiac function and tissue characterization. It is recommended as an effective and efficient diagnostic imaging choice to obtain critical information for clinical diagnosis and decision-making. In this article, we sought the usefulness of CMRI in cardiovascular complications related to COVID-19.

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“…This distribution pattern is typically seen during or after myocarditis (20). In COVID-19 patients with MISC or isolated heart involvement, an identical MRI image with this myocarditis type is seen in all degrees of myocardial involvement (21). Edema in the myocardium can be observed in myocarditis up to 6 months after the disease, depending on the severity of myocardial involvement (22).…”

Section: Late Gadolinium Enhancement Persists In All Patients After S...mentioning

confidence: 99%

Cardiac MRI with late gadolinium enhancement shows cardiac involvement 3–6 months after severe acute COVID-19 similar to or worse than PIMS

Chochkova-Bukova

Funken

Bukova

et al. 2023

Front. Cardiovasc. Med.

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BackgroundCoronavirus disease 2019 (COVID-19) in children is rarely severe. However, severe courses occur, especially in the presence of risk factors. A minority of children develop pediatric inflammatory multisystem syndrome (PIMS) with substantial morbidity. While the importance of cardiac involvement after PIMS is well established, its role after severe acute COVID-19 remains unclear. We aim to compare cardiac sequelae of children after severe acute COVID-19 using cardiac MRI and compare them with patients after PIMS.MethodsFor this prospective cohort study, we recruited patients with acute COVID or PIMS in a single center. Clinical follow-up, lab work, ECG, and echocardiography were done within 2 days after disease onset and 3–6 months after discharge. At the last visit 3–6 months later, cardiac MRI (CMR) with late gadolinium enhancement (LGE) was performed to evaluate cardiac sequelae and compare both groups.ResultsData were obtained from n = 14 patients with PIMS and n = 7 patients with severe acute COVID-19. At the start of the respective disease, left ventricular (LV) ejection fraction was reduced in seven patients with PIMS but none in the acute COVID-19 group. Transient mitral valve insufficiency was present in 38% of patients, of whom PIMS accounted for 7/8 cases. Eight patients (38%) with PIMS presented coronary artery abnormalities, with normalization in 7/8 patients. A significant decrease in LV mass index 3–6 months after disease onset was observed in both groups. MRI follow-up revealed non-ischemic myocardial pattern of LGE in 12/21 patients- in all (6/6) after severe acute COVID-19 and in less than half (6/14) after PIMS. Normal body weight-adjusted stroke volumes and end-diastolic volumes were found in 20/21 patients.ConclusionsWe show that children suffering from severe acute COVID-19 have a similar, or worse, cardiac risk profile as patients with PIMS. Both patient groups should therefore receive close pediatric cardiac follow-up examinations. Cardiac MRI is the technique of choice, as most patients presented with delayed LGE as a sign of persistent cardiac injury despite normalization of laboratory and echocardiographic findings.

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Cardiac Involvement in a Pediatric Patient with COVID-19: Looking Beyond the Nonspecific Global Cardiac Injury

Cited by 3 publications

References 8 publications

SARS-CoV-2 Infection and Associated Cardiovascular Manifestations and Complications in Children and Young Adults: A Scientific Statement From the American Heart Association

SARS-CoV-2 Infection and Associated Cardiovascular Manifestations and Complications in Children and Young Adults: A Scientific Statement From the American Heart Association

Cardiac Magnetic Resonance Imaging in Patients with COVID-19

Cardiac MRI with late gadolinium enhancement shows cardiac involvement 3–6 months after severe acute COVID-19 similar to or worse than PIMS

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