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VOLUME 26 , ISSUE 1 ( January, 2022 ) > List of Articles

Original Article

Electrocardiographic Changes in COVID-19 Patients: A Hospital-based Descriptive Study

Deepalakshmi Kaliyaperumal, Kumar Bhargavi, Karthikeyan Ramaraju, Krishna S Nair, Sudha Ramalingam, Murali Alagesan

Keywords : Coronavirus disease-2019, Electrocardiogram change, Rate abnormalities, ST-T changes

Citation Information : Kaliyaperumal D, Bhargavi K, Ramaraju K, Nair KS, Ramalingam S, Alagesan M. Electrocardiographic Changes in COVID-19 Patients: A Hospital-based Descriptive Study. Indian J Crit Care Med 2022; 26 (1):43-48.

DOI: 10.5005/jp-journals-10071-24045

License: CC BY-NC 4.0

Published Online: 17-01-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Background: Coronavirus disease-2019 (COVID-19) infection is a multisystem disease not restricted to the lungs. It has a negative impact on the cardiovascular system by causing myocardial damage, vascular inflammation, plaque instability, and myocardial infarction. The presence of myocardial injury is a poor prognostic sign. Electrocardiogram (ECG), a simple bedside diagnostic test with high prognostic value, can be employed to assess early cardiovascular involvement in such patients. Various abnormalities in ECG like ST-T changes, arrhythmia, and conduction defects have been reported in COVID-19. We aimed to find out the ECG abnormalities of COVID-19 patients. Methods: We performed a cross-sectional, hospital-based descriptive study among 315 COVID-19 in-patients who underwent ECG recording on admission. Patients’ clinical profiles were noted from their records, and the ECG abnormalities were studied. Results: Among the abnormal ECGs 255 (81%), rhythm abnormalities were seen in 9 patients (2.9%), rate abnormalities in 115 patients (36.5%), and prolonged PR interval in 2.9%. Short QRS complex was seen in 8.3%. QT interval was prolonged in 8.3% of the patients. Significant changes in the ST and T segments (42.9%) were observed. In logistic regression analysis, ischemic changes in ECG were associated with systemic hypertension and respiratory failure. Conclusion: In our study, COVID-19 patients had ischemic changes, rate, rhythm abnormalities, and conduction defects in their ECG. With this ongoing pandemic of COVID-19 and limited health resources, ECG—a simple bedside noninvasive tool is highly beneficial and helps in the early diagnosis and management of cardiac injury.


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  1. 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. DOI: 10.1016/S0140-6736(20)30183-5.
  2. 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). JAMA Cardiol 2020;5(7):819–824. DOI: 10.1001/jamacardio.2020.1096.
  3. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel corona virus infected pneumonia in Wuhan, China. JAMA 2020;323(11):1061–1069. DOI: 10.1001/jama.2020.1585.
  4. Zheng YY, Ma YT, Zhang JY, Xie X. COVID-19 and the cardiovascular system. Nat Rev Cardiol 2020;17(5):259–260. DOI: 10.1038/s41569-020-0360-5.
  5. Lin L, Xu YJ, He DP, Han Y, Tang GH, Yang ZM, et al. A retrospective study on clinical features of and treatment methods for 77 severe cases of SARS. Am J Chin Med 2003;31(6):821–839. DOI: 10.1142/S0192415X03001521.
  6. Lakkireddy DR, Chung MK, Gopinathannair R, Patton KK, Gluckman TJ, Turagam M, et al. Guidance for cardiac electrophysiology during the COVID-19 pandemic from the Heart Rhythm Society COVID-19 Task Force; Electrophysiology Section of the American College of Cardiology; and the Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology, American Heart Association. Circulation 2020;141(21):e823. DOI: 10.1161/CIRCULATIONAHA.120.047063.
  7. AjitMagadum A, Raj Kishore R. Cardiovascular manifestations of COVID-19 infection. Cells 2020;9(11):2508. DOI: 10.3390/cells 9112508.
  8. Puljiz I, Kuzman I, Markotic A, Turcinov D, Matić M, Makek N. Electrocardiographic changes in patients with haemorrhagic fever with renal syndrome. Scand J Infect Dis 2005;37(8):594–598. DOI: 10.1080/00365540510036606.
  9. Makela S, Kokkonen L, Ala-Houhala I, Groundstroem K, Harmoinen A, Huhtala H, et al. More than half of the patients with acute Puumala hantavirus infection have abnormal cardiac findings. Scand J Infect Dis 2009;41(1):57–62. DOI: 10.1080/00365540802502629.
  10. Sacramento E, Lopes AA, Costa E, Passos OL, Costa YA, Matos ED. Electrocardiographic alterations in patients hospitalized with leptospirosis in the Brazilian city of Salvador. Arq Bras Cardiol 2002;78(3):267–270. DOI: 10.1590/s0066-782x2002000300002.
  11. Watt G, Kantipong P, Jirajarus K. Acute scrub typhus in northern Thailand: EKG changes. Southeast Asian J Trop Med Public Health 2002;33(2):312–313. PMID: 12236430.
  12. Lumio JT, Groundstroem KW, Melnick OB, Huhtala H, Rakhmanova AG. Electrocardiographic abnormalities in patients with diphtheria: a prospective study. Am J Med 2004;116(2):78–83. DOI: 10.1016/j.amjmed.2003.08.031.
  13. Puljiz I, Beus A, Kuzman I, Seiwerth S. Electrocardiographic changes and myocarditis in trichinellosis: a retrospective study of 154 patients. Ann Trop Med Parasitol 2005;99(4):403–411. DOI: 10.1179/136485905X36307.
  14. Goldbaum M, Ajimura FY, Litvoc J, de Carvalho SA, Eluf-Neto J. American trypanosomiasis and electrocardiographic alterations among industrial workers in São Paulo, Brazil. Rev Inst Med Trop Sao Paulo 2004;46(6):299–302. DOI: 10.1590/s0036-466520040 00600001.
  15. Shivanthan, MC, Navinan MR, Constantine GR, Rajapakse S. Cardiac involvement in dengue infection. J Infec Dev Ctries 2015;9(4):338–346. PMID: 25881521.
  16. Akritidis N, Mastora M, Baxevanos G, Dimos G, Pappas G. Electrocardiographic abnormalities in patients with novel H1N1 influenza virus infection. Am J Cardiol. 2010 Nov 15;106(10): 1517–1519. DOI: 10.1016/j.amjcard.2010.06.078. Epub 2010 Sep 24. PMID: 21059446.
  17. Shi Y, Wang Y, Shao C, Huang J, Gan J, Huang X, et al. COVID-19 infection: the perspectives on immune responses. Cell Death Differ 2020;27(5):1451–1454. DOI: 10.1038/s41418-020-0530-3.
  18. Clerkin KJ, Fried JA, Raikhelkar J, Sayer G, Griffin JM, Masoumi A, et al. COVID-19 and cardiovascular disease. Circulation 2020;141(20): 1648–1655. DOI: 10.1161/CIRCULATIONAHA.120.046941.
  19. Xiong TY, Redwood S, Prendergast B, Chen M. Coronaviruses and the cardiovascular system: acute and long-term implications. Eur Heart J 2020;41(19):1798–1800. DOI: 10.1093/eurheartj/ehaa231.
  20. Schoenhagen P, Tuzcu EM, Ellis SG. Plaque vulnerability, plaque rupture, and acute coronary syndromes: (multi)-focal manifestation of a systemic disease process. Circulation 2002;106(7):760–762. DOI: 10.1161/01.cir.0000025708.36290.05.
  21. Bergamaschi L, D'Angelo EC, Paolisso P, Toniolo S, Fabrizio M, Angeli F, et al. The value of ECG changes in risk stratification of COVID-19 patients. Ann Noninvasive Electrocardiol 2021;26(3):e12815. DOI: 10.1111/anec.12815.
  22. 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. JAMA 2020;323(11):1061. DOI: 10.1001/jama.2020.1585.
  23. Shi S, Qin M, Shen B, Cai Y, Liu T, Yang F, et al. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. JAMA Cardiol 2020;5(7):802–810. DOI: 10.1001/jamacardio.2020.0950.
  24. Long B, Brady WJ, Bridwell RE, Ramzy M, Montrief T, Singh M, et al. Electrocardiographic manifestations of COVID-19. Am J Emerg Med 2021;41:96–103. DOI: 10.1016/j.ajem.2020.12.060.
  25. Bhatla A, Mayer MM, Adusumalli S, Hyman MC, Oh E, Tierney A, et al. COVID-19 and cardiac arrhythmias. Heart Rhythm 2020;17(9):1439–1444. DOI: 10.1016/j.hrthm.2020.06.016.
  26. Stefanini GG, Montorfano M, Trabattoni D, Andreini D, Ferrante G, Ancona M, et al. ST-elevation myocardial infarction in patients with COVID-19: clinical and angiographic outcomes. Circulation 2020;141(25):2113–2116. DOI: 10.1161/CIRCULATIONAHA.120. 047525.
  27. Roden DM, Harrington RA, Poppas A, Russo AM. Considerations for drug interactions on QTc in exploratory COVID-19 (coronavirus disease 2019) treatment. Circulation 2020;141(24):e906–e907. DOI: 10.1161/CIRCULATIONAHA.120.047521.
  28. Ramireddy A, Chugh H, Reinier K, Ebinger J, Park E, Thompson M, et al. Experience with hydroxychloroquine and azithromycin in the COVID-19 pandemic: implications for QT interval monitoring. J Am Heart Assoc 2020;9(12):e017144. DOI: 10.1161/JAHA.120.017144.
  29. Kho J, Ioannou A, Van den Abbeele K, Mandal AKJ, Missouris CG. Pulmonary embolism in COVID-19: clinical characteristics and cardiac implications. Am J Emerg Med 2020;38(10):2142–2146. DOI: 10.1016/j.ajem.2020.07.054.
  30. Yang D, Li J, Gao P, Chen T, Cheng Z, Cheng K, et al. The prognostic significance of electrocardiography findings in patients with coronavirus disease 2019: a retrospective study. Clin Cardiol 2021;44(7):963–970. DOI: 10.1002/clc.23628.
  31. Wang Y, Chen L, Wang J, He X, Huang F, Chen J, et al. Electrocardiogram analysis of patients with different types of COVID-19. Ann Noninvasive Electrocardiol 2020;25(6):e12806. DOI: 10.1111/anec.12806.
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