A Survey on Cardiac Complications of COVID-19 in Infants

2021 ◽  
Author(s):  
Reza Bahrami ◽  
Sedigheh Ekraminasab ◽  
Fatemeh Asadian
Keyword(s):  
Cardiac Involvement ◽  
Scientific Evidence ◽  
Fatal Outcome ◽  
Cardiovascular Complications ◽  
Cardiac Complications ◽  
Limited Data ◽  
Predisposing Factor ◽  
Young Subjects ◽  
Inflammatory Syndrome ◽  
Underlying Pathophysiology

Congenital heart disease (CHD) may have serious effects on the course of COVID-19. Limited data were available on CHD in neonates with COVID-19. This study aimed to review the cardiac complications in neonates infected with COVID-19. Some studies showed that myocardial injury in adult patients is often correlated with a fatal outcome. But, scientific evidence in infants is rare, although several reports were published with the description of cardiac involvement in COVID-19 pediatric patients. In these young subjects, a background of surgically treated CHD seems to be a predisposing factor. Numerous studies showed Multisystem inflammatory syndrome in children (MIS-c) is a deadly demonstration of COVID-19 with cardiac involvement. The underlying pathophysiology of COVID-19-associated cardiovascular complications is not fully understood, although direct viral infection of the myocardium, systemic inflammatory response, coagulation abnormalities and thrombosis and hypoxia have been suggested as possible mechanisms of cardiac complications. It seems COVID-19 can affect different parts of the heart; however, the myocardium is more involved. The mechanisms of pathogenesis of cardiovascular implications in adults and infants are similar but CHD and MIS-c in infants are more important. Further studies on the effects of COVID-19 on the neonatal cardiovascular system are needed.

scholarly journals Review of Cardiac Involvement in Multisystem Inflammatory Syndrome in Children

Circulation ◽  
2021 ◽  
Vol 143 (1) ◽  
pp. 78-88
Author(s):  
Tarek Alsaied ◽  
Adriana H. Tremoulet ◽  
Jane C. Burns ◽  
Arwa Saidi ◽  
Audrey Dionne ◽  
...  
Keyword(s):  
Inflammatory Response ◽  
Acute Infection ◽  
Gastrointestinal Symptoms ◽  
The United States ◽  
Cardiovascular Complications ◽  
Cardiac Complications ◽  
Published Data ◽  
Control And Prevention ◽  
Cardiac Evaluation ◽  
Inflammatory Syndrome

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with substantial cardiovascular implications. Although infection with SARS-CoV-2 is usually mild in children, some children later develop a severe inflammatory disease that can have manifestations similar to toxic shock syndrome or Kawasaki disease. This syndrome has been defined by the US Centers for Disease Control and Prevention as multisystem inflammatory syndrome in children. Although the prevalence is unknown, >600 cases have been reported in the literature. Multisystem inflammatory syndrome in children appears to be more common in Black and Hispanic children in the United States. Multisystem inflammatory syndrome in children typically occurs a few weeks after acute infection and the putative etiology is a dysregulated inflammatory response to SARS-CoV-2 infection. Persistent fever and gastrointestinal symptoms are the most common symptoms. Cardiac manifestations are common, including ventricular dysfunction, coronary artery dilation and aneurysms, arrhythmia, and conduction abnormalities. Severe cases can present as vasodilatory or cardiogenic shock requiring fluid resuscitation, inotropic support, and in the most severe cases, mechanical ventilation and extracorporeal membrane oxygenation. Empirical treatments have aimed at reversing the inflammatory response using immunomodulatory medications. Intravenous immunoglobulin, steroids, and other immunomodulatory agents have been used frequently. Most patients recover within days to a couple of weeks and mortality is rare, although the medium- and long-term sequelae, particularly cardiovascular complications, are not yet known. This review describes the published data on multisystem inflammatory syndrome in children, focusing on cardiac complications, and provides clinical considerations for cardiac evaluation and follow-up.

Cardiac echocardiogram findings of severe acute respiratory syndrome coronavirus-2-associated multi-system inflammatory syndrome in children

2021 ◽  
pp. 1-9
Author(s):  
Ashraf S. Harahsheh ◽  
Anita Krishnan ◽  
Roberta L. DeBiasi ◽  
Laura J. Olivieri ◽  
Christopher Spurney ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Pericardial Effusion ◽  
Acute Phase ◽  
Systolic Dysfunction ◽  
Interquartile Range ◽  
High Rate ◽  
Cardiac Complications ◽  
Valvular Regurgitation ◽  
Coronary Artery Abnormalities ◽  
Inflammatory Syndrome

Abstract Background: A novel paediatric disease, multi-system inflammatory syndrome in children, has emerged during the 2019 coronavirus disease pandemic. Objectives: To describe the short-term evolution of cardiac complications and associated risk factors in patients with multi-system inflammatory syndrome in children. Methods: Retrospective single-centre study of confirmed multi-system inflammatory syndrome in children treated from 29 March, 2020 to 1 September, 2020. Cardiac complications during the acute phase were defined as decreased systolic function, coronary artery abnormalities, pericardial effusion, or mitral and/or tricuspid valve regurgitation. Patients with or without cardiac complications were compared with chi-square, Fisher’s exact, and Wilcoxon rank sum. Results: Thirty-nine children with median (interquartile range) age 7.8 (3.6–12.7) years were included. Nineteen (49%) patients developed cardiac complications including systolic dysfunction (33%), valvular regurgitation (31%), coronary artery abnormalities (18%), and pericardial effusion (5%). At the time of the most recent follow-up, at a median (interquartile range) of 49 (26–61) days, cardiac complications resolved in 16/19 (84%) patients. Two patients had persistent mild systolic dysfunction and one patient had persistent coronary artery abnormality. Children with cardiac complications were more likely to have higher N-terminal B-type natriuretic peptide (p = 0.01), higher white blood cell count (p = 0.01), higher neutrophil count (p = 0.02), severe lymphopenia (p = 0.05), use of milrinone (p = 0.03), and intensive care requirement (p = 0.04). Conclusion: Patients with multi-system inflammatory syndrome in children had a high rate of cardiac complications in the acute phase, with associated inflammatory markers. Although cardiac complications resolved in 84% of patients, further long-term studies are needed to assess if the cardiac abnormalities (transient or persistent) are associated with major cardiac events.

Impact of the period of the day on mortality and major cardiovascular complications after vascular surgeries

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
F.A.M Cardozo ◽  
T Artioli ◽  
B Caramelli ◽  
D Calderaro ◽  
P.C Yu ◽  
...  
Keyword(s):  
Multivariable Analysis ◽  
Total Mortality ◽  
Mortality Rates ◽  
Cardiovascular Complications ◽  
Cardiac Complications ◽  
Funding Source ◽  
Confounding Variables ◽  
Significant Difference ◽  
One Year ◽  
Night Period

Abstract Introduction Patients submitted to arterial vascular surgeries are at a high risk of postoperative cardiac and non-cardiac complications, therefore developing strategies to lower perioperative complications is essential to optimize outcomes for this subgroup. Recent studies have suggested that the period of the day in which surgeries are performed may influence postoperative major cardiovascular complications but there is still no evidence of this association in vascular surgeries. Purpose Our goal is to evaluate whether the period of the day in which surgeries are performed may influence mortality and cardiovascular outcomes in patients undergoing non-cardiac vascular procedures. Methods Patients who underwent non-cardiac vascular surgeries between 2012 and 2018 were prospectively included at our cohort. For this analysis, subjects were categorized into two groups: those who underwent surgery in the morning (7am - 12am) and those who underwent surgery in the afternoon/night (12:01pm - 6:59am). The primary endpoints were to compare the incidence of major adverse cardiac events (MACE - acute myocardial infarction, acute heart failure, arrhythmias, and cardiovascular death) and total mortality between morning and afternoon/night surgeries within 30 days and one year. The secondary endpoint was the incidence of perioperative myocardial injury (PMI) in both groups. PMI was defined as an absolute elevation of high-sensitivity cardiac troponin T (hs-cTnT) concentrations ≥14ng/L. Multivariable analysis using Cox proportional regression (with Hazard Ratio – HR and Confidence Interval – 95% CI) was performed to adjust for confounding variables, including emergency and urgent surgeries. Results Of 1267 patients included, 1002 (79.1%) underwent vascular surgery in the morning and 265 (20.9%) in the afternoon/night. After adjusting for confounding variables, the incidence of MACE at 30 days was higher among those who underwent surgery in the afternoon/night period (37.4% vs 20.4% – HR 1.43, 95% CI: 1.10–1.85; p=0.008). Mortality rates were also elevated in the afternoon/night group (21.5% vs 9.9%, HR 1.59, 95% CI: 1.10–2.29; p=0.013). After one-year of follow-up the worst outcomes persisted in patients operated in the afternoon/night: higher incidence of MACE (37.7% vs 21.2%, HR 1.37, 95% CI: 1.06–1.78; p=0.017) and mortality (35.8% vs 17.6%, HR 1.72, 95% CI 1.31–2.27; p<0.001). There was no significant difference in the incidence of PMI between groups (p=0.8). Conclusions In this group of patients, being operated in the afternoon/night period was independently associated with increased mortality rates and incidence of MACE. Mortality and MACE at one year Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): FAPESP - Fundação de Amparo a Pesquisa do Estado de São Paulo

scholarly journals Rare Cardiac Mass Assessed by Cardiac Magnetic Resonance

2019 ◽  
Vol 16 (6) ◽  
pp. 77-79
Author(s):  
Sebastian Militaru ◽  
Bernhard Gerber
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Cardiac Involvement ◽  
Specific Treatment ◽  
Cardiac Mass ◽  
Cardiac Complications ◽  
Erdheim Chester Disease ◽  
The Right ◽  
Erdheim Chester ◽  
Chester Disease

AbstractA 43 year old male was referred to our center for assessment of the cardiac involvement in Erdheim-Chester disease (EHD) by cardiac magnetic resonance (CMR). The patient presented with a history of bone involvement as well as retroperitoneal mass, demonstrated to consist fibrosis as well as histiocyte infiltration.The CMR examination included cine (SSFP – steady state free procession), T1 weighted (T1w) and T2 weighted (T2w) sequences, as well as late enhancement images 10 minutes after gadolinium based contrast injection (0.2 mmol/kg). The acquired images showed normal dimensions and function for both right and left cardiac chambers. However, a cardiac mass was revealed in the free wall of the right atrium and the junction with the right ventricle, with clear borders and a diameter of 2.5 cm (Image 1). The tissue was best viewed on axial sequences and was isointense on cine, T1w and T2w images and was mildly enhanced on LGE images. Consequently, the diagnosis of cardiac involvement in EHD was confirmed. The patient was started on specific treatment for EHD and 3-year CMR follow-up showed regression of cardiac involvement.Erdheim-Chester disease is a rare disorder most frequently characterized by non-Langerhans histiocytic multifocal osteosclerotic lesions, with multisystemic granulomatosis and widespread manifestations, as well as highly variable severity(1). ECD affects the cardiovascular system in 75% of patients with infiltration of the pericardium and the right atrioventricular septum being the most common presentation. Typically the mass appears isointense on T1 and T2 weighted images and has low contrast enhancement, as was the case in our patient. In approximately 60% of cases death occurs because of cardiac complications, like pericardial tamponade, myocardial infarction, cardiomyopathy or arrhythmias(2). Patients may sometimes be successfully treated with biologic therapy, interferon alpha or radiotherapy.

scholarly journals COVID-19 and Cardiomyopathy: A Systematic Review

2021 ◽  
Vol 8 ◽  
Author(s):  
Fatemeh Omidi ◽  
Bahareh Hajikhani ◽  
Seyyedeh Neda Kazemi ◽  
Ardeshir Tajbakhsh ◽  
Sajedeh Riazi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Web Of Science ◽  
Cardiac Injury ◽  
Left Ventricular ◽  
Cardiac Complications ◽  
Limited Data ◽  
Cardiac Damage ◽  
Laboratory Findings ◽  
Lv Dysfunction ◽  
D Dimer

Background: Cardiomyopathies (CMPs) due to myocytes involvement are among the leading causes of sudden adolescent death and heart failure. During the COVID-19 pandemic, there are limited data available on cardiac complications in patients with COVID-19, leading to severe outcomes.Methods: We conducted a systematic search in Pubmed/Medline, Web of Science, and Embase databases up to August 2020, for all relevant studies about COVID-19 and CMPs.Results: A total of 29 articles with a total number of 1460 patients were included. Hypertension, diabetes, obesity, hyperlipidemia, and ischemic heart disease were the most reported comorbidities among patients with COVID-19 and cardiomyopathy. In the laboratory findings, 21.47% of patients had increased levels of troponin. Raised D-dimer levels were also reported in all of the patients. Echocardiographic results revealed mild, moderate, and severe Left Ventricular (LV) dysfunction present in 17.13, 11.87, and 10% of patients, respectively.Conclusions: Cardiac injury and CMPs were common conditions in patients with COVID-19. Therefore, it is suggested that cardiac damage be considered in managing patients with COVID-19.

scholarly journals Multi-Inflammatory Syndrome in Children: A View into Immune Pathogenesis from a Laboratory Perspective

2021 ◽  
Author(s):  
Mary Kathryn Bohn ◽  
Peter Yousef ◽  
Shannon Steele ◽  
Lusia Sepiashvili ◽  
Khosrow Adeli
Keyword(s):  
Clinical Laboratory ◽  
Disease Onset ◽  
Cardiovascular Complications ◽  
School Age Children ◽  
Inflammatory Disorder ◽  
Brain Natriuretic Peptides ◽  
Circulating Autoantibodies ◽  
Long Term Impact ◽  
Inflammatory Syndrome

Abstract Background Multi-inflammatory syndrome in children (MIS-C) is a novel and rare inflammatory disorder associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in school-age children. Reports in the past year have suggested a multi-system pathophysiology characterized by hyperinflammation, gastrointestinal distress, and cardiovascular complications. Clinical laboratory investigations, including routine blood testing for inflammatory (e.g., CRP, ferritin) and cardiac (e.g., troponin, brain natriuretic peptides) markers have provided insight into potential drivers of disease pathogenesis, highlighting the role of the laboratory in the differential diagnosis of patients presenting with similar conditions (e.g., Kawasaki Disease, Macrophage Activating Syndrome). Content While few studies have applied high-dimensional immune profiling to further characterize underlying MIS-C pathophysiology, much remains unknown regarding predisposing risk factors, etiology, and long-term impact of disease onset. The extent of autoimmune involvement is also unclear. In the current review, we summarize and critically evaluate available literature on potential pathogenic mechanisms underlying MIS-C onset and discuss the current and anticipated value of various laboratory testing paradigms in MIS-C diagnosis and monitoring. Summary From initial reports, it is clear that MIS-C has unique inflammatory signatures involving both adaptive and innate systems. Certain cytokines, inflammatory markers, and cardiac markers assist in the differentiation of MIS-C from other hyperinflammatory conditions. However, there are still major gaps in our understanding of MIS-C pathogenesis, including T cell, B cell, and innate response. It is essential that researchers not only continue to decipher initial pathogenesis but also monitor long-term health outcomes, particularly given observed presence of circulating autoantibodies with unknown impact.

scholarly journals Cardiac Findings in Pediatric Patients With Multisystem Inflammatory Syndrome in Children Associated With COVID-19

2020 ◽  
pp. 000992282096177 ◽  
Author(s):  
Prashant K. Minocha ◽  
Colin K. L. Phoon ◽  
Sourabh Verma ◽  
Rakesh K. Singh
Keyword(s):  
New York ◽  
Pediatric Patients ◽  
High Rate ◽  
Screening Tests ◽  
Cardiac Complications ◽  
Study Cohort ◽  
Large Hospital ◽  
Inflammatory Syndrome ◽  
Cardiac Testing

Background The overall severity of cardiac disease secondary to acute SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) infection in children appears to be much lower when compared with adults. However, the newly described multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19) has been associated with cardiac complications. Methods We reviewed the clinical course and cardiac testing results in pediatric patients hospitalized with MIS-C at 2 large hospital systems in the New York City metropolitan area over a 3-month period. Results Of the 33 patients (median age 2.8 years) in the study cohort, 24 (73%) had at least one abnormality in cardiac testing: abnormal electrocardiogram (48%), elevated brain natriuretic peptide (43%), abnormal echocardiogram (30%), and/or elevated troponin (21%). Electrocardiogram and echocardiogram abnormalities all resolved by the 2-week outpatient follow-up cardiology visit. Conclusion While 73% of pediatric patients with MIS-C had evidence of abnormal cardiac testing on hospital admission in our study, all cardiac testing was normal by outpatient hospital discharge follow-up. Cardiac screening tests should be performed in all patients diagnosed with MIS-C given the high rate of abnormal cardiac findings in our study cohort.

scholarly journals Echocardiogram: The GPS to GPA’s Heart (Granulomatosis with Polyangiitis)

2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
Manpreet K. Parmar ◽  
Mariam Alikhan ◽  
Vivien M. Hsu ◽  
Amanda Borham
Keyword(s):  
Cardiac Involvement ◽  
Granulomatosis With Polyangiitis ◽  
Case Reports ◽  
Disease Process ◽  
Cardiac Complications ◽  
Primary Role ◽  
Helpful Tool ◽  
Coronary Arteritis ◽  
Granulomatous Vasculitis ◽  
Lower Airways

Granulomatosis with polyangiitis (GPA) is a rare ANCA-associated necrotizing granulomatous vasculitis affecting small- to medium-sized vessels. Common manifestations of this disease process affect the ear, nose, throat, upper and lower airways, and kidneys. Cardiac involvement has been reported in 6–44% of patients, primarily as coronary arteritis and pericarditis. A majority of case reports of pericardial effusions in patients with GPA identify patients having constrictive pericarditis secondary to uremia. We are presenting a case of hemorrhagic pericarditis in a patient with GPA in which the underlying inflammatory vasculitis likely played the primary role in the patient’s presentation. Echocardiographic abnormalities have been found in 80% of patients with GPA. Given the high mortality from cardiac involvement in patients with GPA, screening echocardiograms for this patient population may serve as a helpful tool in gauging disease severity, thereby guiding therapy to prevent serious cardiac complications, such as cardiac tamponade as presented in this case report.

Liver Transplantation in Patients With Cardiac Disease

2017 ◽  
Vol 22 (2) ◽  
pp. 111-121 ◽  
Author(s):  
Christopher L. Wray
Keyword(s):  
Cardiovascular Disease ◽  
Liver Transplantation ◽  
Perioperative Period ◽  
Cardiovascular Complications ◽  
Adverse Outcomes ◽  
Treatment Modalities ◽  
Cardiac Complications ◽  
Major Step ◽  
Cardiac Evaluation ◽  
The Impact

Liver transplantation (LT) is a unique surgical procedure that has major hemodynamic and cardiovascular implications. Recently, there has been significant interest focused on cardiovascular issues that affect LT patients in all phases of the perioperative period. The preoperative cardiac evaluation is a major step in the selection of LT candidates. LT candidates are aging in concordance with the general population; cardiovascular disease and their risk factors are highly associated with older age. Underlying cardiovascular disease has the potential to affect outcomes in LT patients and has a major impact on candidate selection. The prolonged hemodynamic and metabolic instability during LT may contribute to adverse outcomes, especially in patients with underlying cardiovascular disease. Cardiovascular events are not unusual during LT; transplant anesthesiologists must be prepared for these events. Advanced cardiovascular monitoring techniques and treatment modalities are now routinely used during LT. Postoperative cardiovascular complications are common in both the early and late posttransplant periods. The impact of cardiac complications on posttransplant mortality is well recognized. Emerging knowledge regarding cardiovascular disease in LT patients and its impact on posttransplant outcomes will have an important role in guiding the future perioperative management of LT patients.

Sign in / Sign up

Export Citation Format

Share Document