Electrocardiographic Changes in COVID-19 Patients: A Hospital-based Descriptive Study

Abstract

A bstract Background Coronavirus disease-2019 (COVID-19) infection is a multisystem disease not restricted to the lungs. It has a negative impact on the cardiovascular system by causing myocardial damage, vascular inflammation, plaque instability, and myocardial infarction. The presence of myocardial injury is a poor prognostic sign. Electrocardiogram (ECG), a simple bedside diagnostic test with high prognostic value, can be employed to assess early cardiovascular involvement in such patients. Various abnormalities in ECG like ST-T changes, arrhythmia, and conduction defects have been reported in COVID-19. We aimed to find out the ECG abnormalities of COVID-19 patients. Methods We performed a cross-sectional, hospital-based descriptive study among 315 COVID-19 in-patients who underwent ECG recording on admission. Patients’ clinical profiles were noted from their records, and the ECG abnormalities were studied. Results Among the abnormal ECGs 255 (81%), rhythm abnormalities were seen in 9 patients (2.9%), rate abnormalities in 115 patients (36.5%), and prolonged PR interval in 2.9%. Short QRS complex was seen in 8.3%. QT interval was prolonged in 8.3% of the patients. Significant changes in the ST and T segments (42.9%) were observed. In logistic regression analysis, ischemic changes in ECG were associated with systemic hypertension and respiratory failure. Conclusion In our study, COVID-19 patients had ischemic changes, rate, rhythm abnormalities, and conduction defects in their ECG. With this ongoing pandemic of COVID-19 and limited health resources, ECG—a simple bedside noninvasive tool is highly beneficial and helps in the early diagnosis and management of cardiac injury. How to cite this article Kaliyaperumal D, Bhargavi K, Ramaraju K, Nair KS, Ramalingam S, Alagesan M. Electrocardiographic Changes in COVID-19 Patients: A Hospital-based Descriptive Study. Indian J Crit Care Med 2022;26(1):43–48.

Acute coronary events in SARS-CoV-2 - causal or incidental?

“…The higher prevalence of hypertension and diabetes mellitus among patients again highlights the fact that these are major risk factors toward infection with SARS-CoV-2. A study that is done in India by Kaliyaperumal et al,21 consisted of 315 cases with 81% of patients having cardiac involvement among which 36.8% patients had diabetes mellitus and 30.5% had history of hypertension. In this study, systemic hypertension had significant correlation with ischemic changes in ECG.…”

“…Hence, as per the studies there is not only myocardial injury but conduction system involvement is also common as well in patients with infection with SARS-CoV-2. A study is done in India by Kaliyaperumal et al,21 including 315 patients where the abnormal ECG findings included ST elevation in 8.6% patients, ST depression in 3.2% patients, T wave inversion in 23.8% patients, sinus bradycardia in 12.7% patients, prolonged PR interval in 2.9% patients, and irregular rhythm in 2.9% patients. There was higher prevalence of cardiovascular abnormality among the severe and moderate category patients as compared to mild category patients.…”

Description of Clinical Severity, Laboratory Results, and ECG of COVID-19 Patients Who Received Doses I and II of the COVID-19 Vaccine at Haji Adam Malik General Hospital from April to August 2021

“…Several factors that can cause arrhythmias are myocardial infarction, myocarditis, shock, hypoxia, and electrolyte disturbances. [14] About 27.8% of COVID-19 patients in Wuhan have high troponin levels, which indicates damage to the heart muscle. [15] Damage to the heart muscle of a COVID-19 patient can occur due to a cytokine storm which will make white blood cells stick to blood vessels, thus increasing the risk of thrombus formation.…”

Paintable Carbon Nanotube Coating-Based Textronics for Sustained Holter-Type Electrocardiography

“…Moreover, the prolongation in the QRS interval could be the marker of respiratory failure . The European Society of Cardiology recommends routine ECG upon initial assessment and even to monitor treatment progress. , Studies have shown that continuous ECG monitoring during home management of COVID-19 reduces the risk of major adverse events. , Moreover, tracking the oxygen saturation level along with ECG reduces the risk of hospitalization while QRS interval prolongation could be a marker for respiratory failure. This can allow the detection of low levels of oxygen saturation, which is an important parameter indicating severity and progression .…”

“… 9 , 10 Studies have shown that continuous ECG monitoring during home management of COVID-19 reduces the risk of major adverse events. 11 , 12 Moreover, tracking the oxygen saturation level along with ECG reduces the risk of hospitalization while QRS interval prolongation could be a marker for respiratory failure. This can allow the detection of low levels of oxygen saturation, which is an important parameter indicating severity and progression.…”