Cardiac workup and monitoring in hospitalised children with COVID- 19

Fremed, Michael; Lytrivi, Irene D.; Liberman, Leonardo; Anderson, Brett R.; Barry, Oliver M.; Choudhury, Tarif; Chrisomalis-Dring, Sophia; Ferris, Anne; Glickstein, Julie S.; Krishnan, Usha; Levasseur, Stéphanie; Rosenzweig, Erika B.; Shah, Amee; Silver, Eric S.; Suh, Sanghee; Turner, Mariel E.; Weller, Rachel; Woo, Joyce; Starc, Thomas J.

doi:10.1017/s1047951120001778

Cited by 6 publications

(8 citation statements)

References 31 publications

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“…3,4 At our institution, the serology testing does not differentiate between immunoglobulin M and immunoglobulin G; thus, a positive serology test result does not clearly define a resolved infection. ECGs were routinely obtained after admission according to our institution's guidelines for workup of all patients with MIS-C. 6 First-degree AVB on the ECG was defined as a PR interval on a surface ECG .200 milliseconds without associated disruption of atrial-to-ventricular conduction. 7 All ECGs were read by a pediatric cardiologist using electronic calipers.…”

Section: Methodsmentioning

confidence: 99%

MIS-C and Cardiac Conduction Abnormalities

et al. 2020

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OBJECTIVES: Multisystem inflammatory syndrome in children (MIS-C) has spread through the pediatric population during the coronavirus disease 2019 pandemic. Our objective for the study was to report the prevalence of conduction anomalies in MIS-C and identify predictive factors for the conduction abnormalities. METHODS: We performed a single-center retrospective cohort study of pediatric patients <21 years of age presenting with MIS-C over a 1-month period. We collected clinical outcomes, laboratory findings, and diagnostic studies, including serial electrocardiograms, in all patients with MIS-C to identify those with first-degree atrioventricular block (AVB) during the acute phase and assess for predictive factors. RESULTS: Thirty-two patients met inclusion criteria. Median age at admission was 9 years. Six of 32 patients (19%) were found to have first-degree AVB, with a median longest PR interval of 225 milliseconds (interquartile range 200–302), compared with 140 milliseconds (interquartile range 80–178) in patients without first-degree AVB. The onset of AVB occurred at a median of 8 days after the initial symptoms and returned to normal 3 days thereafter. No patients developed advanced AVB, although 1 patient developed a PR interval >300 milliseconds. Another patient developed new-onset right bundle branch block, which resolved during hospitalization. Cardiac enzymes, inflammatory markers, and cardiac function were not associated with AVB development. CONCLUSIONS: In our population, there is a 19% prevalence of first-degree AVB in patients with MIS-C. All patients with a prolonged PR interval recovered without progression to high-degree AVB. Patients admitted with MIS-C require close electrocardiogram monitoring during the acute phase.

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Section: Methodsmentioning

confidence: 99%

MIS-C and Cardiac Conduction Abnormalities

et al. 2020

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“…Should any cardiac concerns arise based on history, exam, or other clinical findings, an ECG should be performed, and cardiology consulted, with performance of echocardiography left to the discretion of the consulting cardiologist. 19 Patients with suspected multi-system inflammatory syndrome in children should undergo more complete cardiac workup based on institutional protocol. This protocol was based on expert opinion and was not uniformly implemented at our institution at the time.…”

Section: Discussionmentioning

confidence: 99%

Elevated cardiac biomarkers and outcomes in children and adolescents with acute COVID-19

et al. 2022

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Cardiac involvement associated with multi-system inflammatory syndrome in children (MIS-C) has been extensively reported, but the prevalence of cardiac involvement in children with SARS-CoV-2 infection in the absence of inflammatory syndrome has not been well described. In this retrospective, single center, cohort study, we describe the cardiac involvement found in this population and report on outcomes of patients with and without elevated cardiac biomarkers. Those with MIS-C, cardiomyopathy, or complex congenital heart disease were excluded. Inclusion criteria were met by 80 patients during the initial peak of the pandemic at our institution. High-sensitivity troponin T and/or NT-proBNP were measured in 27/80 (34%) patients and abnormalities were present in 5/27 (19%), all of whom had underlying comorbidities. Advanced respiratory support was required in all patients with elevated cardiac biomarkers. Electrocardiographic abnormalities were identified in 14/38 (37%) studies. Echocardiograms were performed on 7/80 subjects, and none demonstrated left ventricular dysfunction. Larger studies to determine the true extent of cardiac involvement in children with COVID-19 would be useful to guide recommendations for standard workup and management.

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“…This direct viral invasion, postulated to be caused by the binding of the virus to angiotensin-converting enzyme 2 (ACE2) receptors on the cardiac surface, is based on previous studies that found viral RNA in 35% of myocardial infarctions in people infected with another coronavirus (SARS-CoV). This finding was reinforced in a publication in 2005 ( 5 ). Another more recent study ( 6 ) corroborates this hypothesis, with post-mortem findings in cardiac tissue of spherical viral particles on electron microscopy and viral RNA, confirmed by SARS reverse transcriptase-polymerase chain reaction.…”

Section: Pathogenesis Of Cardiovascular Injury Caused By Sars-cov-2mentioning

confidence: 69%

“…In addition, some studies have reinforced the importance of immune-mediated injury in causing damage to the cardiovascular system. This is secondary to the excessive release of cytokines or deregulation of T cells generated by the presence of the virus, resulting in microvascular damage and endothelial dysfunction ( 5 , 9 - 11 ). Animal studies have also shown that elevated cytokines and inflammatory mediators led to decreased cardiac contractility, possibly mediated by calcium-dependent pathways ( 12 - 14 ).…”

Section: Pathogenesis Of Cardiovascular Injury Caused By Sars-cov-2mentioning

confidence: 99%