Common ECG Changes and Prognostic Importance of ECG Findings in Covid-19 Patients Presenting to the Emergency Department

Abstract

Aim: It is known that cardiac involvement may occur in patients with COVID-19 infection. And one of the best diagnostic tools of cardiac involvement is the ECG. The aim of this study is to investigate the common ECG findings in COVID-19 infection and the effect of these findings on the prognosis. Material and Method: 215 patients who applied to our emergency department between 04.06.2022 and 04.08.2022 and met the criteria for inclusion in the study were included in this study. All patient results and ECG images were accessed from the hospital data recording system. The results were used for statistical analysis. Results: Of 215 patients, 118 were female and 97 were male, and the mean age was 58±21 years. Of these patients, 52 were hospitalized in the service and 17 were hospitalized in intensive care units, and 146 patients were discharged from the emergency department. The most common ECG finding was ST-T wave change. It was observed that there was a correlation between the detection of VT in the ECG and the intensive care unit admission. It was observed that the ECG findings of the patients had no effect on the prognosis. Conclusion: All ECG findings can be seen in patients admitted to the emergency department with COVID-19 infection. The most common ECG finding is ST-T wave change. In addition, long QTc, sinus tachycardia and AF are also common. However, no correlation was found between ECG findings and disease prognosis.

Keywords

• COVID-19
• ECG
• ST-T wave change.

Acil Servise Başvuran Covid-19 Hastalarında sık görülen EKG Değişiklikleri ve EKG Bulgularının Prognostik Önemi

Abstract

amaç: COVID-19 enfeksiyonu olan hastalarda kardiyak etkilenme olabileceği bilinmektedir. Ve kardiyak etkilenmenin en iyi tanı araçlarından bir tanesi EKG’dir. Bu çalışmanın amacı, COVID-19 enfeksiyonunda sık görülen EKG bulguları ve bu bulguların prognoz üzerine etksini araştırmaktır. gereç ve yöntem: Bu çalışmaya. 04.06.2022 ve 04.08.2022 tarihleri arasında acil servisimize başvuran ve çalışmaya dahil olma kritelerini karşılana 215 hasta alınmıştır. Tüm hasta sonuçlarına ve EKG görüntülerine hastane veri kayit sisteminden ulaşılmıştır. Sonuçlar istatistiksel analiz için kullanılmıştır. bulgular: 215 hastanın 118’i kadın 97’si erkekti ve yaş ortalaması 58±21 olarak bulundu. Bu hastalardan 52’si servise 17’si yoğun bakım ünitelerine yatırılmış olup 146 hasta acil servisten taburcu edildi. En sık görülen EKG bulgusu ST-T dalga değilşikliği olarak bulundu. EKG de VT saptanması ile yoğun bakım yatışı arasında ilişki olduğu görüldü. Hastaların EKG bulgularının prognoz üzerine etkisinin olmadığı görüldü. Sonuç: Tüm EKG bulguları COVID-19 enfeksiyonu ile acil servise başvuran hastalarda görülebilmektedir. En sık görülen EKG bulgusu ST-T dalga değişikliğidir. Ayrıca Taşikardi ve AF’de sık görülmektedir. Ancak EKG bulguları ile hastalık prognozu arasında ilişki saptanmamıştır.

Keywords

• COVID-19
• EKG
• ST-T dalga değişikliği

References

1. 1. Huang, C., Wang, Y., Li, X., Ren, L., Zhao, J., Hu, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. 2020. The lancet, 395(10223), 497-506.
2. 2. Zheng YY, Ma YT, Zhang JY, Xie X. COVID-19 and the cardiovascular system. Nat Rev Cardiol. 2020 May;17(5):259-260. doi: 10.1038/s41569-020-0360-5. PMID: 32139904; PMCID: PMC7095524.
3. 3. Akhmerov A, Marbán E. COVID-19 and the Heart. Circ Res. 2020 May 8;126(10):1443-1455. doi: 10.1161/CIRCRESAHA.120.317055. Epub 2020 Apr 7. PMID: 32252591.
4. 4. Inciardi, R. M., Lupi, L., Zaccone, G., Italia, L., Raffo, M., Tomasoni et al. Cardiac involvement in a patient with coronavirus disease 2019 (COVID-19). 2020. JAMA cardiology, 5(7), 819-824.
5. 5. Ramireddy A, Chugh H, Reinier K, Ebinger J, Park E, Thompson M et al. Experience With Hydroxychloroquine and Azithromycin in the Coronavirus Disease 2019 Pandemic: Implications for QT Interval Monitoring. J Am Heart Assoc. 2020 Jun 16;9(12):e017144. doi: 10.1161/JAHA.120.017144. Epub 2020 May 28. PMID: 32463348; PMCID: PMC7429030.
6. 6. 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 Emerg Med. 2021 Aug;46:317-322. doi: 10.1016/j.ajem.2020.10.005. Epub 2020 Oct 7. PMID: 33059987; PMCID: PMC7539927.
7. 7. 3. M Chudzik, E Oszczygiel, D Miskowiec, JD Kasprzak, What can we find in the ECG recording in convalescent from COVID-19 with mild and moderate course, EP Europace, Volume 23, Issue Supplement_3, May 2021, euab116.529.
8. 8. Luo, S., Michler, K., Johnston, P., & Macfarlane, P. W. (2004). A comparison of commonly used QT correction formulae: the effect of heart rate on the QTc of normal ECGs. Journal of electrocardiology, 37, 81-90.

9. 9. Driggin, E., Madhavan, M. V., Bikdeli, B., Chuich, T., Laracy, J., Biondi-Zoccai et al. Cardiovascular considerations for patients, health care workers, and health systems during the COVID-19 pandemic. Journal of the American College of cardiology. 2020. 75(18), 2352-2371.
10. 10. Long, B., Brady, W. J., Koyfman, A., & Gottlieb, M. (2020). Cardiovascular complications in COVID-19. The American journal of emergency medicine, 38(7), 1504-1507.
11. 11. Elias, P., Poterucha, T. J., Jain, S. S., Sayer, G., Raikhelkar, J., Fried et al. The prognostic value of electrocardiogram at presentation to emergency department in patients with COVID-19. In Mayo Clinic Proceedings (Vol. 95, No. 10, pp. 2099-2109). Elsevier. 2020.
12. 12. Li, Y., Liu, T., Tse, G., Wu, M., Jiang, J., Liu, M et al. Electrocardiograhic characteristics in patients with coronavirus infection: a single‐center observational study. Annals of Noninvasive Electrocardiology, 25(6), e12805. 2020.
13. 13. Wang, Y., Chen, L., Wang, J., He, X., Huang, F., Chen, J et al. Electrocardiogram analysis of patients with different types of COVID‐19. Annals of Noninvasive Electrocardiology, 25(6), e12806. 2020.
14. 14. Roden, D. M., Harrington, R. A., Poppas, A., Russo, A. M. Considerations for drug interactions on QTc in exploratory COVID-19 treatment. Circulation, 2020. 141(24), e906-e907.
15. 15. Mercuro, N. J., Yen, C. F., Shim, D. J., Maher, T. R., McCoy, C. M., Zimetbaum, P. J. et al. Risk of QT interval prolongation associated with use of hydroxychloroquine with or without concomitant azithromycin among hospitalized patients testing positive. for coronavirus disease 2019 (COVID-19). JAMA cardiology, 5(9), 1036-1041. 2020.
16. 16. Aromolaran, A. S., Srivastava, U., Alí, A., Chahine, M., Lazaro, D., El-Sherif, N et al. Interleukin-6 inhibition of hERG underlies risk for acquired long QT in cardiac and systemic inflammation. PLoS One, 13(12), e0208321. 2020.
17. 17. Angeli F, Reboldi G, Spanevello A, De Ponti R, Visca D, Marazzato J et al. Electrocardiographic features of patients with COVID-19: One year of unexpected manifestations. Eur J Intern Med. 2022 Jan;95:7-12. . doi: 10.1016/j.ejim.2021.10.006. Epub 2021 Oct 14. PMID: 34670682; PMCID: PMC8514650.
18. 18. Dagher L, Wanna B, Mikdadi G, Young M, Sohns C, Marrouche NF. High-degree atrioventricular block in COVID-19 hospitalized patients. Europace. 2021 Mar 8;23(3):451-455. doi: 10.1093/europace/euaa333. PMID: 33432349; PMCID: PMC7928988.
19. 19. Gopinathannair R, Merchant FM, Lakkireddy DR, Etheridge SP, Feigofsky S, Han JK et al. COVID-19 and cardiac arrhythmias: a global perspective on arrhythmia characteristics and management strategies. . J Interv Card Electrophysiol. 2020 Nov;59(2):329-336. doi: 10.1007/s10840-020-00789-9. Epub 2020 Jun 3. PMID: 32494896; PMCID: PMC7268965.
20. 20. Long B, Brady WJ, Bridwell RE, Ramzy M, Montrief T, Singh M, et al. Electrocardiographic manifestations of COVID-19. Am J Emerg Med. 2021 Mar;41:96-103. doi: 10.1016/j.ajem.2020.12.060. Epub 2020 Dec 29. PMID: 33412365; PMCID: PMC7771377.
21. 21. Turagam, M. K., Musikantow, D., Goldman, M. E., Bassily-Marcus, A., Chu, E., Shivamurthy, Pet al. Malignant arrhythmias in patients with COVID-19: incidence, mechanisms, and outcomes. Circulation: Arrhythmia and Electrophysiology, 2020. 13(11), e008920.
22. 22. Ammirati, E., Cipriani, M., Moro, C., Raineri, C., Pini, D., Sormani, P et al. Clinical presentation and outcome in a contemporary cohort of patients with acute myocarditis: multicenter Lombardy registry. Circulation, 138(11), 1088-1099. 2018.
23. 23. Giudicessi JR, Noseworthy PA, Friedman PA, Ackerman MJ. Urgent Guidance for Navigating and Circumventing the QTc-Prolonging and Torsadogenic Potential of Possible Pharmacotherapies for Coronavirus Disease 19 (COVID-19). Mayo Clin Proc. 2020 Jun;95(6):1213-1221. doi: 10.1016/j.mayocp.2020.03.024. Epub 2020 Apr 7. PMID: 32359771; PMCID: PMC7141471.