Complete Heart Block, Severe Ventricular Dysfunction, and Myocardial Inflammation in a Child With COVID-19 Infection

A case of complete heart block in a COVID-19 infected patient

“…It has been reported that there was a correlation between paradoxical prolongation or lack of shortening of the PR interval with increasing heart rate and higher mortality and intubation rate in COVID-19 patients, suggesting a worse prognosis when conduction abnormalities are present [3]. Cardiac arrhythmias have been reported in association with cardiac injury [2,4,5]. In a large physician survey predominantly involving electrophysiologists, sinus bradycardia and complete heart block were the most observed bradyarrhythmia in hospitalized patients [6].…”

“…Hypercoagulable states and plaque destabilization causing coronary events, and demand ischemia in the setting of severe hypoxia related to respiratory disease are other suggested mechanisms for the COVID-19 related cardiac injury [8]. There have only been few reported cases of complete heart block [4,5]. It is difficult to determine if cardiac arrhythmias that are reported in patient cohorts are related to myocarditis, electrolyte abnormalities, or medication side effects as many of the medications administered to treat the infection are associated with arrhythmia [6].…”

Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Febrile Neonates

“…Myocardial involvement in adults with COVID-19 has been shown to be associated with worse outcomes [ 15 ]. Myocardial involvement during acute infection appears to be rare in children [ 16 ]. Patient 1 developed elevated cardiac biomarkers, elevated D-dimer, elevated clot strength, and mild systolic dysfunction, initially concerning for early viral myocarditis.…”

Atrioventricular Block in Children With Multisystem Inflammatory Syndrome

“…There has been one recent report of transient complete heart block in a child following SARS-CoV-2 infection. 19 The etiology of the AVB remains unclear, but may result from inflammation and edema of the conduction tissue as part of a more diffuse process of myocardial injury.…”

“…The SARS-CoV-2 virus is the cause of the current worldwide coronavirus-19 (COVID- 19) pandemic, with over 5 million confirmed cases. Children were initially thought to be largely spared from severe disease.…”