Electrocardiographic manifestations of COVID-19

Abstract

Introduction Coronavirus disease of 2019 (COVID-19) is a lower respiratory tract infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This disease can impact the cardiovascular system and lead to abnormal electrocardiographic (ECG) findings. Emergency clinicians must be aware of the ECG manifestations of COVID-19. Objective This narrative review outlines the pathophysiology and electrocardiographic findings associated with COVID-19. Discussion COVID-19 is a potentially critical illness associated with a variety of ECG abnormalities, with up to 90% of critically ill patients demonstrating at least one abnormality. The ECG abnormalities in COVID-19 may be due to cytokine storm, hypoxic injury, electrolyte abnormalities, plaque rupture, coronary spasm, microthrombi, or direct endothelial or myocardial injury. While sinus tachycardia is the most common abnormality, others include supraventricular tachycardias such as atrial fibrillation or flutter, ventricular arrhythmias such as ventricular tachycardia or fibrillation, various bradycardias, interval and axis changes, and ST segment and T waves changes. Several ECG presentations are associated with poor outcome, including atrial fibrillation, QT interval prolongation, ST segment and T wave changes, and ventricular tachycardia/fibrillation. Conclusions This review summarizes the relevant ECG findings associated with COVID-19. Knowledge of these findings in COVID-19-related electrocardiographic presentations may assist emergency clinicians in the evaluation and management of potentially infected and infected patients.

Electrocardiography on admission is associated with poor outcomes in coronavirus disease 2019 (COVID‐19) patients: A systematic review and meta‐analysis

“…Several previous reviews have described the manifestations of COVID‐19 patients on ECG abnormalities and the effect of medications such as chloroquine, hydroxychloroquine, and azithromycin on QTc prolongation and its association to poor outcomes. Other studies in patients who were not treated with the drugs mentioned above have found that ECG findings associated with mortality and morbidity limited to PR interval changes, axis changes, unspecific ST‐T abnormalities, and cardiac arrhythmias such as atrial fibrillation (AF), supraventricular tachycardia (SVT), ventricular tachycardia (VT), and ventricular fibrillation (VF) 20,21 . To the best of our knowledge, this is the first systematic review and meta‐analysis to describe the abnormality of each ECG parameter on admission and to evaluate its association with the outcomes of COVID‐19 patients and adds several new findings, where prolonged QRS findings, LBBB, and PACs and PVCs are associated with worse outcomes in COVID‐19 patients.…”

Bedside echocardiography to predict mortality of COVID-19 patients beyond clinical data: Data from the PROVAR-COVID study

“…Regardless of whether COVID-19 exacerbates preexisting CVD or causes new structural/functional abnormalities 24 , early detection of such conditions may be valuable for patient management. Several symptoms of COVID-19, such as chest pain and marked dyspnea, overlap with those of acute CVD 25 , 26 , and observational data suggest that electrocardiographic abnormalities and elevated biomarkers of cardiac injury are also prevalent, especially in severely ill individuals 20 , 24 , 27 . This, along with the high cardiovascular risk profile of hospitalized individuals, as evidenced in our sample, may trigger requests for echo in a large majority of patients.…”

A new predictor for indicating clinical severity and prognosis in COVID-19 patients: Frontal QRS-T angle

“…Previous studies examined the relevance of electrocardiography (ECG) in COVID-19 patients. In these studies, it was reported that many changes such as supraventricular tachycardia, malignant ventricular arrhythmia, bradycardia, atrioventricular block, ST segment, T wave and QRS complex abnormalities and QT prolongation can be observed in COVID-19 patients [ 9 ].…”