tetano
Editor, Senior Moderator
Eur Heart J Case Rep
. 2021 Oct 14;5(12):ytab405.
doi: 10.1093/ehjcr/ytab405. eCollection 2021 Dec.
Bradycardia associated with Multisystem Inflammatory Syndrome in Children with COVID-19: a case series
Gian Paolo Ciccarelli[SUP] 1 [/SUP], Eugenia Bruzzese[SUP] 1 [/SUP], Gaetano Asile[SUP] 2 [/SUP], Edoardo Vassallo[SUP] 1 [/SUP], Luca Pierri[SUP] 1 [/SUP], Vittoria De Lucia[SUP] 2 [/SUP], Alfredo Guarino[SUP] 1 [/SUP], Andrea Lo Vecchio[SUP] 1 [/SUP]
Affiliations
Abstract
Background: Multisystem inflammatory syndrome in children (MIS-C) is a rare life-threatening clinical condition that can develop in patients younger than 21 years of age with a history of infection/exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The cardiovascular system is a main target of the inflammatory process that frequently causes myocardial dysfunction, myopericarditis, coronary artery dilation, hypotension, and shock. Multisystem inflammatory syndrome in children-associated myocarditis is usually characterized by fever, tachycardia, non-specific electrocardiogram abnormalities, and left ventricular dysfunction, but serious tachyarrhythmias may also occur. We report two cases of patients with MIS-C-associated myocarditis who developed severe bradycardia.
Case summary: Two female adolescents with recent history of coronavirus disease 2019 (COVID-19) were initially hospitalized for long-lasting high-grade fever and severe gastrointestinal symptoms. Both patients were diagnosed with MIS-C-associated myocarditis for elevation of markers of myocardial injury (mean highly-sensitive cardiac troponin 2663 pg/mL, mean N-terminal-pro-brain natriuretic peptide 5097 pg/mL) and left ventricular dysfunction, which was subsequently confirmed by cardiac magnetic resonance. Both patients developed a severe sinus bradycardia (lowest heart rate 36 and 42, respectively), which appeared refractory to the treatment with intravenous Methylprednisolone and Immunoglobulins, despite a clinical and biochemical improvement. The use of Anakinra (a recombinant interleukin-1 receptor antagonist), was associated with a rapid improvement of cardiac rhythm and excellent clinical outcome at 6 months of follow-up.
Discussion: In patients with MIS-C-associated myocarditis, a continuous cardiac monitoring is mandatory to promptly identify potential conduction abnormalities. Adolescents may present bradycardia as a rhythm complication. We experienced a rapid recovery after treatment with Anakinra, to be considered as add-on therapy in cases refractory to standard anti-inflammatory treatment.
Keywords: Bradycardia; COVID-19; Case series; Children; MIS-C; Myocarditis; SARS-CoV-2.
. 2021 Oct 14;5(12):ytab405.
doi: 10.1093/ehjcr/ytab405. eCollection 2021 Dec.
Bradycardia associated with Multisystem Inflammatory Syndrome in Children with COVID-19: a case series
Gian Paolo Ciccarelli[SUP] 1 [/SUP], Eugenia Bruzzese[SUP] 1 [/SUP], Gaetano Asile[SUP] 2 [/SUP], Edoardo Vassallo[SUP] 1 [/SUP], Luca Pierri[SUP] 1 [/SUP], Vittoria De Lucia[SUP] 2 [/SUP], Alfredo Guarino[SUP] 1 [/SUP], Andrea Lo Vecchio[SUP] 1 [/SUP]
Affiliations
- PMID: 34993395
- PMCID: PMC8728699
- DOI: 10.1093/ehjcr/ytab405
Abstract
Background: Multisystem inflammatory syndrome in children (MIS-C) is a rare life-threatening clinical condition that can develop in patients younger than 21 years of age with a history of infection/exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The cardiovascular system is a main target of the inflammatory process that frequently causes myocardial dysfunction, myopericarditis, coronary artery dilation, hypotension, and shock. Multisystem inflammatory syndrome in children-associated myocarditis is usually characterized by fever, tachycardia, non-specific electrocardiogram abnormalities, and left ventricular dysfunction, but serious tachyarrhythmias may also occur. We report two cases of patients with MIS-C-associated myocarditis who developed severe bradycardia.
Case summary: Two female adolescents with recent history of coronavirus disease 2019 (COVID-19) were initially hospitalized for long-lasting high-grade fever and severe gastrointestinal symptoms. Both patients were diagnosed with MIS-C-associated myocarditis for elevation of markers of myocardial injury (mean highly-sensitive cardiac troponin 2663 pg/mL, mean N-terminal-pro-brain natriuretic peptide 5097 pg/mL) and left ventricular dysfunction, which was subsequently confirmed by cardiac magnetic resonance. Both patients developed a severe sinus bradycardia (lowest heart rate 36 and 42, respectively), which appeared refractory to the treatment with intravenous Methylprednisolone and Immunoglobulins, despite a clinical and biochemical improvement. The use of Anakinra (a recombinant interleukin-1 receptor antagonist), was associated with a rapid improvement of cardiac rhythm and excellent clinical outcome at 6 months of follow-up.
Discussion: In patients with MIS-C-associated myocarditis, a continuous cardiac monitoring is mandatory to promptly identify potential conduction abnormalities. Adolescents may present bradycardia as a rhythm complication. We experienced a rapid recovery after treatment with Anakinra, to be considered as add-on therapy in cases refractory to standard anti-inflammatory treatment.
Keywords: Bradycardia; COVID-19; Case series; Children; MIS-C; Myocarditis; SARS-CoV-2.