An investigation of cardiac effects in patients presenting to the pandemic clinic with suspected COVID-19

Abstract

Aim: COVID-19 is a virus capable of causing cardiovascular complications. This study investigates whether any cardiac effect is present in patients presenting with suspected COVID-19 in the light of Electrocardiography (ECG) findings. Material and Method: This prospective study involved patients with chest pain presenting to the pandemic clinic with suspected COVID-19. Patients were divided into two groups based on their PCR results, PCR-positive and -negative. All participants’ demographic characteristics, presentation symptoms and the duration thereof, physical examination findings, laboratory results, and ECG findings were recorded. Patients with positive PCR results were invited for checks on the 15th day, when repeat ECG was performed. Results: A-50 patients with positive PCR results and 50 with negative PCR results were included in the study. The mean age of the entire patient group was 52.30±16.02 years, and 56% were women. No difference was determined between the positive and negative PCR result patients in terms of age or sex (p=0.116; 0.687, respectively). Presentation high sensitive cardiac Troponin (hs-cTn) levels were significantly higher in the patients with positive PCR results than in the PCR-negative patients (p<0.001). Rates of detection of ST-T change at presentation ECG were 38% in the patients with positive PCR results and 16% in those with negative PCR results (p=0.023). ST-T alteration persisted at 15th day ECG in 36% of the patients with positive PCR results. P-wave amplitude and mean heart rate were significantly higher at presentation ECG in the patients with positive PCR results than at ECG on day fifteen (p=0.038; <0.001 respectively). Conclusion: A cardiac effect does occur in patients with COVID-19, and this can be shown by means of ECG findings. The increase in P-wave amplitude at presentation ECG in patients with positive PCR results may represent a marker of COVID-19-related cardiac overload. ECG should be performed both at presentation and in the following days on COVID-19 patients presenting with chest pain, and care should be taken against potential ischemic ST-T alterations.

Keywords

• COVID-19
• Electrocardiography
• Emergency Department
• Troponin

COVID-19 şüphesi nedeniyle pandemi polikliniğine başvuran hastalarda kardiyak etkilenmenin araştırılması

Abstract

Amaç: COVID-19 kardiyovasküler komplikasyonlara neden olabilen bir virüstür. Bu çalışmada, COVID-19 şüphesi ile başvuran göğüs ağrılı hastalarda kardiyak etkilenme olup olmadığı Elektrokardiyografi (EKG) bulguları eşliğinde araştırılmıştır. Gereç ve Yöntem: Bu çalışma, Pandemi polikliniğine COVID-19 şüphesi ile başvuran göğüs ağrılı hastalar üzerinde prospektif olarak yapıldı. Hastalar PCR sonucuna göre: PCR sonucu pozitif ve negatif olmak üzere iki gruba ayrıldı. Tüm katılımcıların demografik özellikleri, başvuru şikayetleri ve şikayetlerinin mevcudiyet süresi, fizik muayene bulguları, laboratuvar sonuçları ve EKG bulguları kaydedildi. PCR sonucu pozitif olan hastalar, 15. günde kontrole çağırılarak yeniden EKG çekildi. Bulgular: Çalışmaya 50 PCR sonucu pozitif ve 50 PCR sonucu negatif hasta dahil edildi. Tüm hastaların yaş ortalaması 52.30±16.02/yıl ve %56’sı kadındı. PCR sonucu pozitif olanlarla PCR sonucu negatif olanlar arasında yaş ve cinsiyet bakımından farklılık saptanmadı (Sırasıyla p=0.116; 0.687). Başvuru yüksek duyarlıklı kardiyak Troponin (hs-cTn) düzeyi, PCR sonucu pozitif olanlarda PCR sonucu negatif olanlara göre anlamlı olarak daha yüksekti (p<0.001). Başvuru EKG’sinde ST-T değişikliği saptanma oranı PCR sonucu pozitif olanlarda %38 iken, PCR sonucu negatif olanlarda ise %16 idi (p=0.023). PCR sonucu pozitif olan hastaların %36’sının 15. gün EKG’sinde ST-T değişikliği izlenmeye devam ediyordu. PCR sonucu pozitif olan hastaların başvuru EKG’sinde P-dalga amplitüdü ve ortalama kalp hızı değeri 15. gün EKG’sine göre anlamlı olarak daha yüksekti (Sırasıyla p=0.038; <0.001). Sonuç: COVID-19 hastalarında kardiyak bir etkilenme olmakta ve bu durum EKG bulguları vasıtasıyla gösterilebilmektedir. PCR sonucu pozitif hastaların başvuru EKG’sinde saptanan P-dalga amplitüdündeki artış, COVID-19’a bağlı kardiyak yüklenmenin göstergesi olabilir. Göğüs ağrısı ile başvuran COVID-19 hastalarına hem başvuru anında hem de ilerleyen günlerde EKG çekimi yapılmalı ve oluşabilecek iskemik ST-T değişikliklerine karşı dikkatli olunmalıdır.

Keywords

• COVID-19
• Elektrokardiyografi
• Acil servis
• Troponin

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