Multisystem inflammatory syndrome in adults (MIS-A) following COVID-19 requiring venoarterial extracorporeal membrane oxygenation.

The SARS-CoV-2 virus has caused a global pandemic with serious impact around the world. Patients most commonly present with severe lung involvement and acute respiratory failure; however, multisystem inflammatory syndrome in adults (MIS-A) is a known-although rare-complication. We present a case of a 49-year-old patient who presented with combined cardiogenic and vasodilatory shock and was diagnosed with MIS-A. He initially required venoarterial extracorporeal membrane oxygenation and Impella for haemodynamic support but was able to be weaned off these devices with complete recovery of left ventricular systolic function. This case demonstrates that MIS-A may present as haemodynamic collapse in adults, but complete recovery is possible with proper haemodynamic support.

Electrocardiographic Features of Patients with COVID-19: An Updated Review.

Numerous systemic manifestations, including cardiac involvement in the form of myocardial infarction, myocarditis, and electrocardiographic changes, have been associated with COVID-19..In this review, the authors describe the electrocardiographic features that have been reported to date in patients affected by this disease and their possible underlying mechanisms.

Prevalence, Outcomes, and Management of Ventricular Arrhythmias in COVID-19 Patients.

We review the current data on epidemiology, the clinical significance, the pathophysiologic mechanisms, and the treatment of VAs in the setting of COVID-19. VAs prevail in 0.15% to 8% of hospitalized patients, but only sustained and rapid tachyarrhythmias are purportedly associated with a significant increase in mortality. Multiple factors can elicit VAs, which are ultimately deemed to be a marker of severe systemic disease rather than a distinct cardiac condition. Even though the electrophysiologist plays a determinant role in the secondary prevention of VAs, a multidisciplinary approach is indispensable for primary prophylaxis and acute management.

Cardiac Injury and COVID-19: A Systematic Review and Meta-analysis.

BACKGROUND: During the current COVID-19 pandemic, a link between acute cardiac injury and COVID-19 infection has been observed. There is currently no consensus on the incidence of cardiac injury, its relationship to prognosis, or its possible cause. In this article we provide a comprehensive review and meta-analysis of the incidence, comorbidities, outcomes, and possible mechanisms of acute cardiac injury in COVID-19 patients. METHODS: We searched PubMed and Embase for studies that evaluated cardiac injury in hospitalized COVID-19 patients. Data on demographic information, comorbidities, and relevant laboratory values were extracted and a meta-analysis was performed. RESULTS: Sixteen studies from China, Italy, and the United States with 2224 patients were included in this meta-analysis. The incidence of cardiac injury was 24.4% (542/2224 patients) in hospitalized COVID-19 patients. The all-cause mortality in patients with cardiac injury was 72.6% (odds ratio, 17.32; 95% confidence interval, 9.21-32.57) compared with those without cardiac injury (14.5%). In subgroup analyses, factors associated with increased risk of developing cardiac injury were older age and history of hypertension, and chronic obstructive respiratory disease. CONCLUSIONS: Cardiac injury is common in hospitalized COVID-19 patients and is significantly associated with mortality. Patients who were older with hypertension and chronic obstructive respiratory disease were prone to develop cardiac injury. Early screening, triage, and cardiac monitoring are recommended for these patients.

CONTEXTE: Durant la pandémie de COVID-19 qui sévit actuellement, un lien a été observé entre l'infection par le virus de la COVID-19 et l'apparition de lésions cardiaques aiguës. À l'heure actuelle, il n'y a pas de consensus quant à l'incidence de telles lésions cardiaques, à leur lien avec le pronostic ou à leur cause possible. Nous présentons ici une revue exhaustive et une méta-analyse de l'incidence des lésions cardiaques aiguës chez les patients atteints de COVID-19 ainsi que des affections concomitantes, des issues et des mécanismes qui pourraient y être associés. MÉTHODOLOGIE: Nous avons effectué une recherche dans les bases de données PubMed et Embase afin de recenser les études évaluant les lésions cardiaques chez les patients atteints de COVID-19 admis à l'hôpital. Les caractéristiques démographiques des patients ainsi que les données sur les affections concomitantes et d'autres paramètres de laboratoire pertinents ont été extraites des études recensées, puis soumises à une méta-analyse. RÉSULTATS: La méta-analyse portait sur les données de 16 études réalisées en Chine, en Italie et aux États-Unis qui regroupaient 2 224 patients au total. L'incidence des lésions cardiaques chez les patients atteints de COVID-19 hospitalisés s'établissait à 24,4 % (542 patients sur 2 224). La mortalité toutes causes confondues chez les patients présentant des lésions cardiaques était de 72,6 % (rapport de cotes : 17,32; intervalle de confiance à 95 % : 9,21 à 32,57) comparativement à 14,5 % chez les patients sans lésions cardiaques. Dans les analyses par sous-groupe, les facteurs associés à un risque accru d'apparition de lésions cardiaques étaient l'âge plus avancé et des antécédents d'hypertension, ainsi que la présence d'une maladie respiratoire obstructive chronique. CONCLUSIONS: Les lésions cardiaques sont fréquentes chez les patients atteints de COVID-19 hospitalisés et sont associées de manière significative à la mortalité. Les patients plus âgés ayant des antécédents d'hypertension et atteints d'une maladie respiratoire obstructive chronique étaient plus susceptibles de présenter des lésions cardiaques. Un dépistage précoce, un triage approprié et une surveillance cardiaque sont recommandés chez ces patients.