Electrocardiographic manifestations of COVID-19
Brit Long1, William J Brady2, Rachel E Bridwell3
1Assistant Program Director - Research, SAUSHEC, Emergency Medicine, Brooke Army Medical Center, United States of America.
Insights
Coronavirus disease 2019 (COVID-19) can cause significant cardiac issues, leading to abnormal electrocardiographic (ECG) findings in up to 90% of critical patients. Understanding these ECG changes is vital for emergency clinicians managing COVID-19 patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Emergency Medicine
Background:
- Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, is a respiratory illness with potential cardiovascular implications.
- Abnormal electrocardiographic (ECG) findings are frequently observed in patients with COVID-19.
- Emergency clinicians require awareness of these ECG manifestations for effective patient management.
Purpose of the Study:
- To provide a narrative review of the pathophysiology of COVID-19 concerning the cardiovascular system.
- To outline and describe the various electrocardiographic (ECG) findings associated with COVID-19 infection.
Main Methods:
- This study is a narrative review.
- It synthesizes existing literature on COVID-19's cardiovascular effects and associated ECG changes.
Main Results:
- Up to 90% of critically ill COVID-19 patients exhibit at least one ECG abnormality.
- Common abnormalities include sinus tachycardia, supraventricular and ventricular arrhythmias, bradycardias, interval/axis changes, and ST-T wave alterations.
- Potential causes include cytokine storm, hypoxia, electrolyte imbalances, plaque rupture, coronary spasm, microthrombi, and direct myocardial injury.
Conclusions:
- COVID-19 is linked to diverse ECG abnormalities, impacting patient outcomes.
- Specific ECG findings like atrial fibrillation, QT prolongation, ST-T wave changes, and ventricular arrhythmias are associated with poor prognosis.
- Recognizing these ECG patterns aids emergency clinicians in evaluating and managing COVID-19 patients.
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 wave 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.
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