Cardiac Involvement in Children Affected by COVID-19: Clinical Features and Diagnosis

Elena Vasichkina; Daria Alekseeva; Vadim Karev; Ekaterina Podyacheva; Igor Kudryavtsev; Anzhela Glushkova; Anastasia Y Starshinova; Dmitry Kudlay; Anna Starshinova

doi:10.3390/diagnostics13010120

Cardiac Involvement in Children Affected by COVID-19: Clinical Features and Diagnosis

Diagnostics (Basel). 2022 Dec 30;13(1):120. doi: 10.3390/diagnostics13010120.

Authors

Affiliations

¹ Almazov National Medical Research Centre, St. Petersburg 197341, Russia.
² H. Turner National Medical Research Center for Children's Orthopedics and Trauma Surgery of the Ministry of Health of the Russian Federation, St. Petersburg 196603, Russia.
³ Children's Clinical Research Center for Infectious Diseases, St. Petersburg 194100, Russia.
⁴ Institute of Experimental Medicine, St. Petersburg 197376, Russia.
⁵ V.M. Bekhterev National Research Medical Center for Psychiatry and Neurology, St. Petersburg 192019, Russia.
⁶ Medical Department, Saint Petersburg State Pediatric Medical University, St. Petersburg 194100, Russia.
⁷ Pharmacology Department, I.M. Sechenov First Moscow State Medical University, Moscow 119992, Russia.
⁸ Institute of Immunology, Moscow 115522, Russia.

Abstract

COVID-19 (Coronavirus disease 2019) in children is usually mild. However, multiple organ disorders associated with SARS-CoV-2 (severe acute respiratory syndrome-related coronavirus 2) have been detected with poor respiratory symptoms. Cardiac changes are noted in 17% to 75% of cases, which are associated with diagnostic difficulties in high-risk groups for the development of complications that are associated with myocardial damage by the SARS-CoV-2 virus. The objective of this review is to identify the most significant symptoms of cardiac involvement affected by COVID-19, which require in-depth examination. The authors analyzed publications from December 2019 to the October 2022, which were published in accessible local and international databases. According to the analysis data, the main sign of myocardial involvement was increasing as cardiomarkers in the patient's blood, in particular troponin I or troponin T. Many authors noted that the increased level of CRP (C-reactive protein) and NT-proBNP, which are accompanied by changes in the ECG (electrocardiogram) and EchoCG (echocardiography), as a rule, were nonspecific. However, the identified cardiac functional dysfunctions affected by SARS-CoV-2, required an cardiac MRI. The lack of timely diagnosis of myocardial involvements, especially in children at high risk for the development of complications associated with SARS-CoV-2 myocardial injury, can lead to death. The direct damage of the structural elements of myocardial blood vessels in patients with severe hypoxic changes resulted from respiratory failure caused by SARS-CoV-2 lung damage, with the development of severe acute diffuse alveolar damage and cell-mediated immune response and myocardial involvement affected by SARS-CoV-2 damage. In this article, the authors introduce a clinical case of a child who dead from inflammatory myocardities with COVID-19 in a background of congenital heart disease and T-cell immunodeficiency.

Keywords: COVID-19; Myocarditis; SARS-CoV-2; cardiovascular inflammation; children; coronavirus infection.

Publication types

Review

Grants and funding

075-15-2022-301/Ministry of Science and Higher Education of the Russian Federation