Hostname: page-component-78c5997874-v9fdk Total loading time: 0 Render date: 2024-11-16T13:23:52.010Z Has data issue: false hasContentIssue false
  • English
  • Français

COVID-19-associated multisystem inflammatory syndrome in children presenting uniquely with sinus node dysfunction in the setting of shock

Part of: Echocardiography

Published online by Cambridge University Press:  22 March 2021

Lesya G. Tomlinson Open the ORCID record for Lesya G. Tomlinson [Opens in a new window] ,
Mitchell I. Cohen ,
Rebecca E. Levorson  and
Megan B. Tzeng
Lesya G. Tomlinson*
Affiliation:
Department of Pediatrics, INOVA Fairfax Children’s Hospital, 3300 Gallows Road, Falls Church, VA22042, USA
Mitchell I. Cohen
Affiliation:
Department of Electrophysiology and Cardiology, INOVA Fairfax Children’s Hospital, 3300 Gallows Road, Falls Church, VA22042, USA
Rebecca E. Levorson
Affiliation:
Department of Infectious Disease, Pediatric Specialists of Virginia, 3023 Hamaker Ct Suite 600, Fairfax, VA22031, USA
Megan B. Tzeng
Affiliation:
Department of Pediatric Critical Care Medicine, INOVA Fairfax Children’s Hospital, 3300 Gallows Road, Falls Church, VA22042, USA
*
Author for correspondence: Lesya G. Tomlinson, Department of Pediatrics, INOVA Fairfax Children’s Hospital, 3300 Gallows Road, Falls Church, VA22042, USA. Tel: 703-776-6652; Fax: 703-776-6432. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

SARS-CoV-2, which causes the disease COVID-19, generally has a mild disease course in children. However, a severe post-infectious inflammatory process known as multisystem inflammatory syndrome in children has been observed in association with COVID-19. This inflammatory process is a result of an abnormal immune response with similar clinical features to Kawasaki disease. It is well established that multisystem inflammatory syndrome in children is associated with myocardial dysfunction, coronary artery dilation or aneurysms, and occasionally arrhythmias. The most common electrocardiographic abnormalities seen include premature atrial or ventricular ectopy, variable degrees of atrioventricular block, and QTc prolongation, and rarely, haemodynamically significant arrhythmias necessitating extracorporeal membrane oxygenation support. However, presentation with fever, hypotension, and relative bradycardia with a left axis idioventricular rhythm has not been previously reported. We present a case of a young adolescent with multisystem inflammatory syndrome in children with myocarditis and a profoundly inappropriate sinus node response to shock with complete resolution following intravenous immunoglobulin.

Keywords

COVID-19shockidioventricular rhythmmultisystem inflammatory syndrome in children
Type
Brief Report
Information
Cardiology in the Young , Volume 31 , Issue 7 , July 2021 , pp. 1202 - 1204
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Riphagen, S, Gomez, X, Gonzalez-martinez, C, et al. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet 2020; 395: 1607–1608.CrossRefGoogle ScholarPubMed
Henderson, LA, Canna, SW, Friedman, KG, et al. American college of rheumatology clinical guidance for pediatric patients with Multisystem Inflammatory Syndrome in Children (MIS‐C) associated with SARS‐CoV‐2 and hyperinflammation in COVID‐19. Version 1. Arthritis Rheumatol 2020. Accepted Author Manuscript. doi:10.1002/art.41454 CrossRefGoogle Scholar
Son, MB, Friedman, K. Coronavirus disease 2019 (COVID-19): Multisystem inflammatory syndrome in children. In: Fulton, D, Kaplan, S, Sundel, R, Randolph, A, Armsby, C, TePas, E (eds). UpToDate, 2020. Available from https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-multisysteminflammatory-syndrome-in-children?search=MISc&source=search_result&selectedTitle=1~55&usage_type=default&display_rank=1 Google Scholar
Feldstein, LR, Rose, EB, Horwitz, SM, et al. Multisystem inflammatory syndrome in U.S. children and adolescents. N Engl J Med 2020; 383: 334–346. doi:10.1056/NEJMoa2021680 CrossRefGoogle ScholarPubMed
Deza Leon, MP, Redzepi, A, McGrath, E, et al. COVID-19–Associated pediatric multisystem inflammatory syndrome. J Pediatric Infect Dis Soc 2020: 1–2.Google ScholarPubMed
Belhadjer, Z, Méot, M, Bajolle, F, et al. Acute heart failure in multisystem inflammatory syndrome in children in the context of global SARS-CoV-2 pandemic. Circulation 2020; 142: 429–436. doi:10.1161/circulationaha.120.048360 CrossRefGoogle ScholarPubMed
Whittaker, E, Bamford, A, Kenny, J, et al. Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV2. JAMA - J Am Med Assoc 2020: 1–11.Google Scholar
Toubiana, J, Poirault, C, Corsia, A, et al. Kawasaki-like multisystem inflammatory syndrome in children during the covid-19 pandemic in Paris, France: prospective observational study. Br Med J 2020: 1–7.Google ScholarPubMed
Belhadjer, Z, Méot, M, Bajolle, F, et al. Acute heart failure in multisystem inflammatory syndrome in children (MIS-C) in the context of global SARS-CoV-2 pandemic. Circulation 2020; 33.Google Scholar