Electrocardiographic changes in non-hospitalised children with COVID-19

Objectives: Many children diagnosed with COVID-19 infections did not require hospitalisation. Our objective was to analyse electrocardiographic changes in children with asymptomatic, mild or moderate COVID-19 who did not require hospitalisation Methods: All children are seen in a paediatric cardiology clinic who had asymptomatic, mild or moderate COVID-19 that did not require hospitalisation and had at least one electrocardiogram after their diagnosis were included in this retrospective analysis. Records were reviewed to determine COVID-19 disease severity and presence of Long COVID. Rhythm assessment, atrial enlargement, ventricular hypertrophy, PR/QRS/QT interval duration and ST-T wave abnormalities were analysed by a paediatric electrophysiologist. Clinically ordered echocardiograms were reviewed for signs of myopericarditis (left ventricular ejection fraction and pericardial effusion) on any subject with an electrocardiographic abnormality. Results: Of the 82 children meeting inclusion criteria (14.4 years, range 1–18 years, 57% male), 17 patients (21%) demonstrated electrocardiographic changes. Ten patients (12%) had electrocardiogram of borderline significance, which included isolated mild PR prolongation or mild repolarisation abnormalities. The other seven patients (9%) had concerning electrocardiographic findings consisting of more significant repolarisation abnormalities. None of the patients with an abnormal electrocardiogram revealed any echocardiographic abnormality. All abnormal electrocardiograms normalised over time except in two cases. Across the entire cohort, greater COVID-19 disease severity and long COVID were not associated with electrocardiographic abnormalities. Conclusions: Electrocardiographic abnormalities are present in a minority of children with an asymptomatic, mild or moderate COVID-19 infection. Many of these changes resolved over time and no evidence of myopericarditis was present on echocardiography.

Severe Oleander Poisoning Presenting with Hyperkalaemia and Unusual Electrocardiographic Changes

Background: Hyperkalaemia in oleander (Nerium oleander) poisoning has been associated with a poor prognosis. Different electrocardiographic (ECG) presentations are possible because of vagotonia and hyperkalaemia. Methods/Results: We report a series of three cases of oleander poisoning in which ECG showed unusual hyperkalaemia features, such as bradyarrhythmia, sinoatrial block, atrioventricular block and junctional rhythm. Conclusions: If arterial blood gas analysis or laboratory values indicate hyperkalaemia in oleander poisoning, the hyperkalaemia should be treated immediately, even if the ECG does not show typical hyperkalaemia features.

Electrocardiographic Changes in Type-1 Diabetes Mellitus Children with Diabetic Ketoacidosis Presenting to Tertiary care Hospital, Karachi

Introduction: Cardiac arrhythmias and arrest have been described in children with diabetic ketoacidosis and generally have been presumed to be caused by electrolyte abnormalities. The rationale of this study was to assess the role and importance of ECG monitoring, as a simple, quick, non-invasive and readily available tool in the diagnosis and confirmation of hypokalemia and hyperkalemia in patients with DKA in the Emergency Department Objective: To Assess the Frequency of electrocardiographic changes in Type-1 diabetes mellitus children with diabetic ketoacidosis presenting to tertiary care hospital, Karachi. Materials and Methods: This retrospective cross sectional study was carried out at the department of pediatric medicine, NICH Karachi. At the time of presentation, the standard 12-lead ECG was recorded by a single pediatric cardiologist having more than 2 years of experience, QT and RR intervals were measured. Three separate measurements were obtained from each ECG, and the mean of these measurements was used as the value for QTC. QTC of at least 0.45s (450ms) was considered as prolonged QTC. QTD was also assessed at the same time and QTD>50 ms was considered as prolonged QTD. Results: One hundred cases of T1DM with DKA were included in this study. Average age of children was 7.9 ±3.5 years (Min – Max = 0.5 – 14 years), male to female ratio was 1: 0.96. Prolong QTc and QTd interval was observed in (56%) and (38%) children respectively, Mean (±SD) QTc and QTd interval was 449.4 ±36.6 mc and 39.3 ±16.1 mc respectively. While ECG changes were found in (58%) cases. Association between ECG changes and the cases with higher RBS (>350 mg/dl) was statistically significant 81 (81%) cases with ECG changes had higher RBS (p<0.0001) while ECG changes were statistically similar in both age groups and gender (p-values > 0.05). Conclusion: The frequency of ECG changes was higher in T1DM children with diabetic ketoacidosis. ECG changes was significantly associated with higher RBS (>350 mg/dl). Key words: T1DM, Diabetic Ketoacidosis, ECG, QTc, QTd

Asymptomatic takotsubo syndrome occurring during Holter monitoring

Asymptomatic takotsubo syndrome was observed during periodic Holter monitoring in a man in his 60s undergoing maintenance dialysis. No emotional or physical stress was noticed. The electrocardiographic changes at onset were determined, and repeated ST elevation and progressive formation of giant negative T waves were recorded.

Left Ventricular Ballooning Patterns in Recurrent Takotsubo Cardiomyopathy: A Systematic Review and Meta-analysis of Reported Cases

Recurrent takotsubo cardiomyopathy (TTC) and the clinical profiles and outcomes of patients have not been fully evaluated, nor has the effect of left ventricular ballooning pattern. After searching the medical literature for reports of patients with recurrent TTC, we identified 84 articles with 101 case descriptions. We divided the cases into those with only apical left ventricular ballooning patterns at recurrence (typical, n=60), and those with at least one midventricular or basal ballooning pattern (atypical, n=41). We then compared their clinical profiles and outcomes. The groups were similar in terms of baseline demographic characteristics, presence and types of triggers, use of heart failure medications at TTC recurrence, electrocardiographic changes at presentation, initial left ventricular ejection fractions, timespans between recurrent TTC episodes, and recovery times after each event. However, patients in the atypical group had significantly fewer severe adverse events (cardiogenic shock and cardiac arrest) than did those in the typical group, with an estimated 63% lower odds (adjusted odds ratio=0.37; 95% CI, 0.14–0.97; P=0.039). Survival to hospital discharge was statistically similar but lower in the typical group (n=53; 88.3%) than in the atypical group (n=24; 96%). Our results suggest that left ventricular ballooning patterns influence clinical outcomes, and that outcomes are more favorable in patients with recurrent TTC who have atypical left ventricular ballooning patterns.

PARVOVIRUS B19 INDUCED MYOCARDITIS, SIMULATING ACUTE MYOCARDIAL INFARCTION

Myocarditis is an inflammation of the myocardium associated with mechanical or electrical dysfunctions that usually lead to inappropriate ventricular dilatation or hypertrophy. A number of inciting factors are known to cause myocarditis- genetic defects, viruses, bacteria, parasites, granulomatous inflammations, collagen vascular disorders, chemotherapeutic agents- to name a few. Among the viruses, Adenovirus, Coxsackie virus, Human Herpes virus six and Parvovirus B19 are the encountered pathogens. We hereby present a case of a 14 years old boy who presented with typical cardiac chest pain associated with electrocardiographic changes of ST segment elevation MI in theinferior leads. Cardiac biomarkers were elevated, adding to the diagnostic confusion of MI. On subjecting the patient to a coronary angiography, his arteries were found to be patent, directing us towards the diagnosis of myocarditis. After getting a cardiac MRI and serum tests, the diagnosis of fulminant myocarditis induced by Parvovirus B19 was made. Fortunately, the patient survived on inotropes and other supportive therapy which helped him overcome the cardiac failure.