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Arrhythmias and ECG abnormalities in COVID-19

  • July 01,2021
  • 2 Min Read
Arrhythmias and ECG abnormalities in COVID-19

Arrhythmias may complicate hospitalized patients with COVID-19 in up to 16.7% of cases and tend to prolong the ICU stay. The arrhythmia mechanisms are highly variable and include supraventricular tachycardia, polymorphic ventricular tachycardia (VT) and torsade.

The exact etiology of arrhythmias is unclear at present, but besides the usual culprits (like - hypoxia, inflammatory cascade, myocarditis), drug therapy such as chloroquine, hydroxychloroquine, moxifloxacin and azithromycin can also be etiologic factors.

Indications for ECG in COVID-19:

·         Baseline ECG in all with evidence of moderate or severe COVID-19 infection

·         Anyone with pre-existing cardiovascular disease or high-risk factor burden

·         Those with arrhythmia

·         Marked cardiac troponin elevation

·         Typical acute coronary syndrome symptoms

·         Daily ECGs in those given hydroxychloroquine

ECG abnormalities observed in COVID-19 patients:

·         Rhythm abnormalities-

o   Ventricular tachycardia

o   Torsades de pointes

o   Atrial fibrillation

o   Supra ventricular tachycardia

·         Specific abnormalities-

o   ST elevation in I, II, aVL and V2-6. Coronary angiography demonstrated non-occlusive coronary artery disease

o   Sinus tachycardia in patients with cardiogenic shock and severe left ventricular dysfunction

o   Premature atrial and ventricular complexes, lateral-wave inversion and prolonged QT

o   Sinus rhythm with non-specific ST and T-wave changes

Coronary angiography should be performed in those with reciprocal ECG changes and high sensitivity troponin elevation, particularly if progressive.

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