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Common ECG Manifestations of COVID-19

Common ECG Manifestations of COVID-19

Since the inception of the COVID-19 pandemic, much of the focus has been on the respiratory system, but COVID-19 can also cause a multitude of cardiac complications and electrocardiographic abnormalities that we need to be aware of. ECG abnormalities that have been seen in patients with COVID-19 are thought to be related to cytokine storm, hypoxic injury, electrolyte abnormalities, plaque rupture, coronary spasm, microthrombosis, or direct endothelial or myocardial injury. While there is an increased risk of cardiac arrest in patients hospitalized with COVID-19, the cardiac rhythms associated with cardiac arrest vary.

Recent research has described several cardiac complications of COVID-19, including myocarditis, cardiac tamponade, a Brugada-like pattern on the ECG, transient ST segment elevations, and medication-induced cardiac dysrhythmias. It has been demonstrated that patients with COVID-19 who have myocardial involvement tend to have poor outcomes, especially those with myocardial injury. As healthcare providers, it is vital that we are able to recognize COVID-19-associated ECG abnormalities and their implication in risk stratification.

Sinus tachycardia appears to be the most common abnormality noted, resulting from hypovolemia, hypoperfusion, hypoxia, elevated body temperature, pain, and anxiety. Atrial fibrillation is the next most commonly seen supraventricular tachycardia, but other arrhythmias noted include ventricular arrhythmias such as ventricular tachycardia or fibrillation, various bradycardias, interval and axis changes, and ST segment and T wave changes. Studies suggest that the ECG presentations we should be especially aware of are atrial fibrillation, QT prolongation, ST segment and T wave changes, and ventricular tachycardia/fibrillation, as these are the abnormalities most associated with poor outcomes.

While scientific evidence continues to unfold, cardiac monitoring will continue to play a key role in treatment planning for patients with COVID-19. Studies have proffered that the standard ECG may be helpful for an initial risk stratification of patients admitted for COVID-19. Therefore, all providers should be vigilant about watching for ECG changes, defer to advanced imaging when needed, and be diligent in monitoring for other abnormalities that could indicate higher mortality issues.

  • Driggin E, et al. Cardiovascular considerations for patients, health care workers, and health systems during the COVID-19 pandemic. J Am Coll Cardiol. 2020;75:2352-2371.
  • Long B, et al. Cardiovascular complications in COVID-19. Am J Emerg Med. 2020;38:1504-1507.
  • Wang L, et al. Prognostic value of myocardial injury in patients with COVID-19. Zhonghua Xin Xue Guan Bing Za Zhi. 2020;48:461-466. Chinese.

Filed under: Cardiometabolic, Infectious Diseases

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