COVID-19 electrocardiogram: Difference between revisions
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*COVID-19 has been associated with complete hart block, acute coronary syndromes, myocarditis, decompensated heart failure, and pulmonary embolisms.<ref name="Amaratunga Corwin2020">{{cite journal|last1=Amaratunga |first1=Eluwana A|last2=Corwin|first2=Douglas S|last3=Moran|first3=Lynn|last4=Snyder|first4=Richard|title=Bradycardia in Patients With COVID-19: A Calm Before the Storm?|journal=Cureus|year=2020|issn=2168-8184|doi=10.7759/cureus.8599}}</ref> | *COVID-19 has been associated with complete hart block, acute coronary syndromes, myocarditis, decompensated heart failure, and pulmonary embolisms.<ref name="Amaratunga Corwin2020">{{cite journal|last1=Amaratunga |first1=Eluwana A|last2=Corwin|first2=Douglas S|last3=Moran|first3=Lynn|last4=Snyder|first4=Richard|title=Bradycardia in Patients With COVID-19: A Calm Before the Storm?|journal=Cureus|year=2020|issn=2168-8184|doi=10.7759/cureus.8599}}</ref> | ||
ECG changes in the severe stages of COVID-19 have been attributed to possible hypoxia and inflammatory damage incurred by the virus.<ref name="HeWu2020">{{cite journal|last1=He|first1=Jia|last2=Wu|first2=Bo|last3=Chen|first3=Yaqin|last4=Tang|first4=Jianjun|last5=Liu|first5=Qiming|last6=Zhou|first6=Shenghua|last7=Chen|first7=Chen|last8=Qin|first8=Qingwu|last9=Huang|first9=Kang|last10=Lv|first10=Jianlei|last11=Chen|first11=Yan|last12=Peng|first12=Daoquan|title=Characteristic Electrocardiographic Manifestations in Patients With COVID-19|journal=Canadian Journal of Cardiology|volume=36|issue=6|year=2020|pages=966.e1–966.e4|issn=0828282X|doi=10.1016/j.cjca.2020.03.028}}</ref> | *ECG changes in the severe stages of COVID-19 have been attributed to possible hypoxia and inflammatory damage incurred by the virus.<ref name="HeWu2020">{{cite journal|last1=He|first1=Jia|last2=Wu|first2=Bo|last3=Chen|first3=Yaqin|last4=Tang|first4=Jianjun|last5=Liu|first5=Qiming|last6=Zhou|first6=Shenghua|last7=Chen|first7=Chen|last8=Qin|first8=Qingwu|last9=Huang|first9=Kang|last10=Lv|first10=Jianlei|last11=Chen|first11=Yan|last12=Peng|first12=Daoquan|title=Characteristic Electrocardiographic Manifestations in Patients With COVID-19|journal=Canadian Journal of Cardiology|volume=36|issue=6|year=2020|pages=966.e1–966.e4|issn=0828282X|doi=10.1016/j.cjca.2020.03.028}}</ref> | ||
*COVID-19 and acute myopericarditis: | *COVID-19 and acute myopericarditis: | ||
**low voltage in the limb leads, minimal diffuse ST-segment elevation (more prominent in the inferior and lateral leads), and an ST-segment depression with T-wave inversion in lead V1 and aVR.<ref name="InciardiLupi2020">{{cite journal|last1=Inciardi|first1=Riccardo M.|last2=Lupi|first2=Laura|last3=Zaccone|first3=Gregorio|last4=Italia|first4=Leonardo|last5=Raffo|first5=Michela|last6=Tomasoni|first6=Daniela|last7=Cani|first7=Dario S.|last8=Cerini|first8=Manuel|last9=Farina|first9=Davide|last10=Gavazzi|first10=Emanuele|last11=Maroldi|first11=Roberto|last12=Adamo|first12=Marianna|last13=Ammirati|first13=Enrico|last14=Sinagra|first14=Gianfranco|last15=Lombardi|first15=Carlo M.|last16=Metra|first16=Marco|title=Cardiac Involvement in a Patient With Coronavirus Disease 2019 (COVID-19)|journal=JAMA Cardiology|year=2020|issn=2380-6583|doi=10.1001/jamacardio.2020.1096}}</ref> | **low voltage in the limb leads, minimal diffuse ST-segment elevation (more prominent in the inferior and lateral leads), and an ST-segment depression with T-wave inversion in lead V1 and aVR.<ref name="InciardiLupi2020">{{cite journal|last1=Inciardi|first1=Riccardo M.|last2=Lupi|first2=Laura|last3=Zaccone|first3=Gregorio|last4=Italia|first4=Leonardo|last5=Raffo|first5=Michela|last6=Tomasoni|first6=Daniela|last7=Cani|first7=Dario S.|last8=Cerini|first8=Manuel|last9=Farina|first9=Davide|last10=Gavazzi|first10=Emanuele|last11=Maroldi|first11=Roberto|last12=Adamo|first12=Marianna|last13=Ammirati|first13=Enrico|last14=Sinagra|first14=Gianfranco|last15=Lombardi|first15=Carlo M.|last16=Metra|first16=Marco|title=Cardiac Involvement in a Patient With Coronavirus Disease 2019 (COVID-19)|journal=JAMA Cardiology|year=2020|issn=2380-6583|doi=10.1001/jamacardio.2020.1096}}</ref> | ||
**ECG signs of acute pericarditis concave ST elevation and PR depression throughout most of the limb (I, II, III, aVL, aVF) and precordial (V2-V6) leads, reciprocal ST depression and PR elevation in aVR, and a ST segment/T wave ratio> 0.25. COVID-19 induced pericarditis might reflect the expression of ACE2 receptors in epicardial adipocites, mediating the cell entry of SARS-CoV-2 and possibly triggering local inflammation.<ref name="Amaratunga Corwin2020">{{cite journal|last1=Amaratunga |first1=Eluwana A|last2=Corwin|first2=Douglas S|last3=Moran|first3=Lynn|last4=Snyder|first4=Richard|title=Bradycardia in Patients With COVID-19: A Calm Before the Storm?|journal=Cureus|year=2020|issn=2168-8184|doi=10.7759/cureus.8599}}</ref> | **ECG signs of acute pericarditis concave ST elevation and PR depression throughout most of the limb (I, II, III, aVL, aVF) and precordial (V2-V6) leads, reciprocal ST depression and PR elevation in aVR, and a ST segment/T wave ratio> 0.25. COVID-19 induced pericarditis might reflect the expression of ACE2 receptors in epicardial adipocites, mediating the cell entry of SARS-CoV-2 and possibly triggering local inflammation.<ref name="Amaratunga Corwin2020">{{cite journal|last1=Amaratunga |first1=Eluwana A|last2=Corwin|first2=Douglas S|last3=Moran|first3=Lynn|last4=Snyder|first4=Richard|title=Bradycardia in Patients With COVID-19: A Calm Before the Storm?|journal=Cureus|year=2020|issn=2168-8184|doi=10.7759/cureus.8599}}</ref> | ||
**sinus rhythm with a first-degree atrioventricular block (AVB) with SITIIIQIII;Sinus tachycardia with incomplete right bundle branch block and slightly elevated ST segment.<ref name="HeWu2020">{{cite journal|last1=He|first1=Jia|last2=Wu|first2=Bo|last3=Chen|first3=Yaqin|last4=Tang|first4=Jianjun|last5=Liu|first5=Qiming|last6=Zhou|first6=Shenghua|last7=Chen|first7=Chen|last8=Qin|first8=Qingwu|last9=Huang|first9=Kang|last10=Lv|first10=Jianlei|last11=Chen|first11=Yan|last12=Peng|first12=Daoquan|title=Characteristic Electrocardiographic Manifestations in Patients With COVID-19|journal=Canadian Journal of Cardiology|volume=36|issue=6|year=2020|pages=966.e1–966.e4|issn=0828282X|doi=10.1016/j.cjca.2020.03.028}}</ref> | |||
*Relative bradycardia in Patients With COVID-19: | *Relative bradycardia in Patients With COVID-19: | ||
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* There are no specific [[ECG]] findings associated with coronavirus [[infection]]. | * There are no specific [[ECG]] findings associated with coronavirus [[infection]]. | ||
* Non specific findings can include [[sinus tachycardia]], ST-elevation and diffuse [[T wave]] inversion.<ref name="pmid26922692">{{cite journal |vauthors=Alhogbani T |title=Acute myocarditis associated with novel Middle east respiratory syndrome coronavirus |journal=Ann Saudi Med |volume=36 |issue=1 |pages=78–80 |date=2016 |pmid=26922692 |pmc=6074274 |doi=10.5144/0256-4947.2016.78 |url=}}</ref> | * Non specific findings can include [[sinus tachycardia]], ST-elevation and diffuse [[T wave]] inversion.<ref name="pmid26922692">{{cite journal |vauthors=Alhogbani T |title=Acute myocarditis associated with novel Middle east respiratory syndrome coronavirus |journal=Ann Saudi Med |volume=36 |issue=1 |pages=78–80 |date=2016 |pmid=26922692 |pmc=6074274 |doi=10.5144/0256-4947.2016.78 |url=}}</ref> | ||
Revision as of 02:49, 27 June 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sabawoon Mirwais, M.B.B.S, M.D.[2]; Syed Hassan A. Kazmi BSc, MD [3]
Overview
There are no specific ECG findings associated with coronavirus infection. Non specific findings can include sinus tachycardia, ST-elevation and diffuse T wave inversion.
Electrocardiogram
- Most of the findings are ST-T abnormalities,and left ventricular hypertrophy, atrial fibrillation,tachy-brady syndrome, and changes consistent with acute pericarditis.[1]
- COVID-19 has been associated with complete hart block, acute coronary syndromes, myocarditis, decompensated heart failure, and pulmonary embolisms.[1]
- ECG changes in the severe stages of COVID-19 have been attributed to possible hypoxia and inflammatory damage incurred by the virus.[2]
- COVID-19 and acute myopericarditis:
- low voltage in the limb leads, minimal diffuse ST-segment elevation (more prominent in the inferior and lateral leads), and an ST-segment depression with T-wave inversion in lead V1 and aVR.[3]
- ECG signs of acute pericarditis concave ST elevation and PR depression throughout most of the limb (I, II, III, aVL, aVF) and precordial (V2-V6) leads, reciprocal ST depression and PR elevation in aVR, and a ST segment/T wave ratio> 0.25. COVID-19 induced pericarditis might reflect the expression of ACE2 receptors in epicardial adipocites, mediating the cell entry of SARS-CoV-2 and possibly triggering local inflammation.[1]
- sinus rhythm with a first-degree atrioventricular block (AVB) with SITIIIQIII;Sinus tachycardia with incomplete right bundle branch block and slightly elevated ST segment.[2]
- Relative bradycardia in Patients With COVID-19:
- The pathogenesis is poorly understood,cardiac pacemaker cells may be a target for inflammatory cytokines resulting in a change in heart rate dynamics or their responsiveness to neurotransmitters during systemic inflammation. This is particularly interesting because recent studies show evidence of severe deterioration in some patients with COVID-19 being closely related to the cytokine storm.[4].
- The inflammatory cytokines released during the stage of overwhelming immune response, acting on the cardiac pacemaker cells could possibly contribute to bradycardia. It may be that the high levels of pro-inflammatory cytokines, including IL-6 directly act on the sinoatrial (SA) node.[1].
- There are no specific ECG findings associated with coronavirus infection.
- Non specific findings can include sinus tachycardia, ST-elevation and diffuse T wave inversion.[5]
References
- ↑ 1.0 1.1 1.2 1.3 Amaratunga, Eluwana A; Corwin, Douglas S; Moran, Lynn; Snyder, Richard (2020). "Bradycardia in Patients With COVID-19: A Calm Before the Storm?". Cureus. doi:10.7759/cureus.8599. ISSN 2168-8184.
- ↑ 2.0 2.1 He, Jia; Wu, Bo; Chen, Yaqin; Tang, Jianjun; Liu, Qiming; Zhou, Shenghua; Chen, Chen; Qin, Qingwu; Huang, Kang; Lv, Jianlei; Chen, Yan; Peng, Daoquan (2020). "Characteristic Electrocardiographic Manifestations in Patients With COVID-19". Canadian Journal of Cardiology. 36 (6): 966.e1–966.e4. doi:10.1016/j.cjca.2020.03.028. ISSN 0828-282X.
- ↑ Inciardi, Riccardo M.; Lupi, Laura; Zaccone, Gregorio; Italia, Leonardo; Raffo, Michela; Tomasoni, Daniela; Cani, Dario S.; Cerini, Manuel; Farina, Davide; Gavazzi, Emanuele; Maroldi, Roberto; Adamo, Marianna; Ammirati, Enrico; Sinagra, Gianfranco; Lombardi, Carlo M.; Metra, Marco (2020). "Cardiac Involvement in a Patient With Coronavirus Disease 2019 (COVID-19)". JAMA Cardiology. doi:10.1001/jamacardio.2020.1096. ISSN 2380-6583.
- ↑ Ye, Qing; Wang, Bili; Mao, Jianhua (2020). "The pathogenesis and treatment of the `Cytokine Storm' in COVID-19". Journal of Infection. 80 (6): 607–613. doi:10.1016/j.jinf.2020.03.037. ISSN 0163-4453.
- ↑ Alhogbani T (2016). "Acute myocarditis associated with novel Middle east respiratory syndrome coronavirus". Ann Saudi Med. 36 (1): 78–80. doi:10.5144/0256-4947.2016.78. PMC 6074274. PMID 26922692.