Electrocardiographic findings in COVID-19 patients

Abstract

Background: Severe acute respiratory syndrome coronavirus 2 (SARS CoV2) has caused the global pandemic, COVID-19. Though predominantly a respiratory illness, cardiac manifestations of COVID-19 significantly contribute to mortality. We wanted to determine whether admission electrocardiographic (ECG) characteristics provide prognostic information in COVID-19.Methods: We performed a retrospective, cross-sectional observational study in a designated District COVID hospital. COVID-19 patient’s medical records were converted into an electronic database which included demographic data, clinical characteristics and electrocardiogram recorded at/near the time of admission. Primary outcome assessed was the occurrence of severe COVID-19.Results: Of 180 patients, the majority were males (67.8%) and aged 31-50 years (38.9%). The predominant comorbidity among patients who were discharged (non-severe COVID-19 disease) and those who got referred (severe COVID-19 disease) was hypertension (56.5% vs 43.3%), followed by diabetes mellitus (37.7% vs 36.7%). Fatigue (41.9%) and cough (18.5%) were the most frequent symptoms among non-severe cases. Of 32.8% of the patients with abnormal ECG, abnormal axis (25.5%), poor R wave progression (23.5%), T inversion (15.3%), left ventricular hypertrophy (12.2%) followed by ST segment depression (8.3%) were the frequent findings. Logistic regression analysis revealed that elderly patients (>60 years) (β=2.276, OR=9.737, p=0.002), Heart rate (β=0.191, OR=1.211, p=0.045) and ST segment depression (β=9.986, OR=21725.39, p=0.022) showed statistically significant positive association with Severe COVID-19.Conclusions: ST segment abnormalities on admission ECG are markers of cardiac injury and may assist in prognostication of COVID-19. Early identification of these findings might play a crucial role in identifying patients likely to progress to severe COVID-19.

Changes in dynamic electrocardiogram after COVID-19 infection: a self-controlled study

“…The electrocardiogram may show ST segment elevation or depression, T-wave depression, bidirectional or inverted changes after COVID-19. ST segment elevation can be seen in myocarditis or pericarditis, while ST segment depression and T-wave changes can be seen in myocardial ischemia, which may be caused by obstructive coronary artery disease or oxygen supply-demand imbalance [20,21]. A meta-analyse is showed that up to 40% of COVID-19 patients from different hospitals worldwide experience ST-T changes, some of which are accompanied by elevated troponin levels.…”

Myocardial Ischemia in Patients with COVID-19 Infection: Between Pathophysiological Mechanisms and Electrocardiographic Findings

“…Patients infected with SARS-CoV-2 who associate myocardial injury may show ST-segment elevation, ST-segment depression, or T-wave inversion on ECG [ 18 , 19 ]. Howbeit, the ST-segment elevation in COVID-19 patients requires differential diagnosis with pericarditis and myocarditis, while myocardial ischemia may be due to both obstructive coronary artery diseases and a mismatch between oxygen supply and demand [ 88 ]; these findings have been observed more frequently in severe patients [ 13 , 22 ]. Among the critically ill patients, an abnormal ECG with ST-T changes reaches a frequency of 48.5%, while in patients with a severe type of COVID-19, 25.7% have this abnormality according to Wang et al [ 89 ].…”

“…Most studies found that ST-T abnormalities were the most common changes, occurring in up to 40% of patients from different hospitals, including Wuhan Asia General Hospital [ 15 , 19 , 88 , 90 ]. T-wave inversion was the most common repolarization change in several studies, including the one of Galidevara et al, who reported that 27.7% of ECG changes were due to this abnormality [ 7 , 22 ]. However, while Rosen et al reported in his study that 21% patients had an ECG with ST-T modification, Poterucha et al reported that 10% of the presentations had this abnormality, T-wave inversion was observed in up to 29% of this group, which is similar to other studies.…”

“…The ST-T modifications on the ECG can be used as an indicator for poor prognosis, including more frequent need for mechanical ventilatory support, increased need for ICU admission, and finally increased mortality [ 13 , 19 , 89 ]. Patients with ST-T changes on the admission ECG are more likely to show progression towards a severe form, being associated with the severity of the COVID-19 infection and a worse prognosis [ 13 , 22 , 95 ]. Therefore, the COVID-19 patients detected with myocardial ischemia on the ECG should be monitored for sudden cardiac death [ 13 ].…”

“…The ECG changes in myocardial ischemia include a broad spectrum in patients with COVID-19, different cases of ST-segment elevation, ST-segment depression, and T-wave inversion being reported, which were associated with a severe form of COVID-19 disease [ 21 , 22 ]. Several authors have described P-wave changes, in the context of atrial infarction, which is supplied in 60% of cases by the right coronary artery and in 40% by the circumflex artery through the superior ramus ostium cava [ 23 ].…”