Electrocardiographic findings in COVID-19 patients

Authors

  • Jyothi Galidevara Department of General Medicine, Gayatri Vidya Parishad Institute of Healthcare and Medical Technology, Visakhapatnam, Andhra Pradesh, India
  • Veeramani Kartheek A. S. Department of General Medicine, Government Medical College, Srikakulam, Andhra Pradesh, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20210410

Keywords:

COVID-19, Electrocardiogram, Cardiac manifestations

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.

Author Biographies

Jyothi Galidevara, Department of General Medicine, Gayatri Vidya Parishad Institute of Healthcare and Medical Technology, Visakhapatnam, Andhra Pradesh, India

ASSISTANT PROFESSOR, DEPARTMENT OF GENERAL MEDICINE

Veeramani Kartheek A. S., Department of General Medicine, Government Medical College, Srikakulam, Andhra Pradesh, India

ASSISTANT PROFESSOR, DEPARTMENT OF GENERAL MEDICINE

References

Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients with 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. J Am Med Assoc. 2020;323(11):1061-9.

Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med. 2020;8(4):420-2.

Zheng Y-Y, Ma Y-T, Zhang J-Y, Xie X. COVID-19 and the cardiovascular system. Nat Rev Cardiol. 2020;17(5):259e260.

Aggarwal G, Cheruiyot I, Aggarwal S, Wong J, Lippi G, Lavie CJ, et al. Association of cardiovascular disease with coronavirus disease 2019 (COVID-19) severity: a meta-analysis. Curr Prob Cardiol. 2020:100617.

Zeng J, Huang J, Pan L. How to balance acute myocardial infarction and COVID-19: the protocols from Sichuan Provincial People’s Hospital. Intens Care med. 2020;46(6):1111-3.

Inciardi RM, Lupi L, Zaccone G, Italia L, Raffo M, Tomasoni D, et al. Cardiac involvement in a patient with coronavirus disease 2019 (COVID-19). J Am Med Assoc Cardiol. 2020.

Clerkin KJ, Fried JA, Raikhelkar J, Sayer G, Griffin JM, Masoumi A, et al. COVID-19 and cardiovascular disease. Circulation. 2020;141(20):1648-55.

Madjid M, Safavi-Naeini P, Solomon SD, Vardeny O. Potential Effects of Coronaviruses on the Cardiovascular System: A Review. J Am Med Assoc Cardiol. 2020;5(7):831-40.

Deng Q, Hu B, Zhang Y. Suspected myocardial injury in patients with COVID-19: evidence from front-line clinical observation in Wuhan, China. Int J Cardiol. 2020;311:116e121.

He J, Wu B, Chen Y. Characteristic ECG manifestations in patients with COVID-19. Can J Cardiol. 2020;36(6):966.E1e966.E4.

Rautaharju PM, Kooperberg C, Larson JC, LaCroix A. Electrocardiographic predictors of incident congestive heart failure and all-cause mortality in post-menopausal women: the Women’s Health Initiative. Circulation. 2006;113:481-9.

Daviglus ML, Liao Y, Greenland P, Dyer AR, Liu K, Xie X, et al. Association of nonspecific minor ST-T abnormalities with cardiovascular mortality: the Chicago Western Electric Study. J Am Med Assoc. 1999;282:530-6.

The Coronary Drug Project Research Group. The prognostic importance of the electrocardiogram after myocardial infarction. Experience from the Coronary Drug Project. Ann Intern Med. 1972;77:677-9.

Okin PM, Devereux RB, Jern S, Kjeldsen SE, Julius S, Nieminen MS, et al. Regression of electrocardiographic left ventricular hypertrophy during antihypertensive treatment and prediction of major cardiovascular events: the LIFE Study. J Am Med Assoc. 2004;292:2343-9.

Ministry of Health & Family Welfare, Government of India. Clinical Management Protocol: COVID-19. Version 5 dated 03.07.20. Directorate General of Health Services (EMR Division), Available at https://www.mohfw.gov.in/pdf/UpdatedClinicalManagementProtocolforCOVID19dated03072020.pdf. Accessed on 07 July 2020.

Department of Health, Medical and Family welfare, Government of Andhra Pradesh,2020. Availabe at https://hmfw.ap.gov.in/COVID-19%20IEC/COVID-19%20Hospitals.pdf . Accessed on 01 July 2020.

Department of Health, Medical and Family welfare, Government of Andhra Pradesh, 2020. https://hmfw.ap.gov.in/COVID-19%20IEC/4.GOI%20Guidelines%20and%20Advisories/InstantOrders/COVID%20Instant%20Order%20-10.pdf. Accessed on 01 July 2020.

Esfandiarei M, McManus BM. Molecular biology and pathogenesis of viral myocarditis. Annu Rev Pathol. 2008;3:12-55.

Veronese G, Ammirati E, Cipriani M, Frigerio M. Fulminant myocarditis: characteristics, treatment, and outcomes. Anatol J Cardiol. 2018;19:279-86.

Ho JS, Tambyah PA, Ho AF, Chan MY, Sia CH. Effect of coronavirus infection on the human heart: a scoping review. Eur J Prev Cardiol. 2020; 27(11):1136-48.

Tavazzi G, Pellegrini C, Maurelli M, Belliato M, Sciutti F, Bottazzi A et al. Myocardial localization of coronavirus in COVID-19 cardiogenic shock. Eur J Heart Fail. 2020 M;22(5):911-5.

Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.

Shi S, Qin M, Shen B, et al. Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. J Am Med Assoc Cardiol. 2020;5(7):802-10.

Sia CH, Ngiam JN, Chew N, Beh DL, Poh KK. An educational case series of electrocardiographs during the COVID-19 pandemic and their implications on therapy. Singapore Med J. 2020;1:15.

Zeng JH, Liu YX, Yuan J, Wang FX, Wu WB, Li JX, et al. First case of COVID-19 complicated with fulminant myocarditis: a case report and insights. Infection. 2020:1.

Kim IC, Kim JY, Kim HA, Han S. COVID-19-related myocarditis in a 21-year-old female patient. Eur Heart J. 2020;41(19):1859.

Hu H, Ma F, Wei X, Fang Y. Coronavirus fulminant myocarditis treated with glucocorticoid and human immunoglobulin. Europ Heart J. 2020.

Wang Y, Chen L, Wang J. Electrocardiogram analysis of patients with different types of COVID-19. Ann Noninvasive Electrocardiol. 2020;25:e12806.

Cherian R, Poh KK. At the ‘heart’ of the COVID-19 outbreak: early cardiac implications and mitigating strategies. Singapore Med J. 2020;61:373-74.

Saad M, Omrani AS, Baig K, et al. Clinical aspects and outcomes of 70 patients with Middle East Respiratory Syndrome coronavirus infection: a single-center experience in Saudi Arabia. Int J Infect Dis. 2014;29:301-6.

Sizun J, Soupre D, Legrand MC. Neonatal nosocomial respiratory infection with coronavirus: a prospective study in a neonatal intensive care unit. Acta Paediatr. 1995;84:617-20.

Öztürk F, Karaduman M, Çoldur R, İncecik Ş, Güneş Y, Tuncer M. Interpretation of arrhythmogenic effects of COVID-19 disease through ECG. Aging Male. 2020:1-4.

Barman HA, Atici A, Alici G, Sit O, Tugrul S, Gungor B, et al. The effect of the severity COVID-19 infection on electrocardiography. Am J Emergen Medic. 2020.

Liao Y, LIu K, Dyer A, Schoenberger JA, Shekelle R, Collette P, et al. Sex differential in the relationship of electrocardiographic ST-T abnormalities to risk of coronary death: 11.5 year follow-up findings of the Chicago heart association detection pro- ject in industry. Circulation. 1987;75(2):347-52.

Deng Q, Hu B, Zhang Y, Wang H, Zhou X, Hu W, et al. Suspected myocardial injury in patients with COVID-19: Evidence from front-line clinical observation in Wuhan, China. International journal of cardiology. 2020.

Downloads

Published

2021-01-29

How to Cite

Galidevara, J., & A. S., V. K. (2021). Electrocardiographic findings in COVID-19 patients. International Journal of Research in Medical Sciences, 9(2), 378–385. https://doi.org/10.18203/2320-6012.ijrms20210410

Issue

Section

Original Research Articles