COVID19: potential cardiovascular issues in pediatric patients
Keywords:
COVID – 19, Children Cardiovascular, Myocarditis, Kawasaki disease, Congenital heart diseases.Abstract
The novel severe acute respiratory syndrome coronavirus 2 (SARS-COV 2) has rapidly spread worldwide with increasing hospitalization and mortality rate. Ongoing studies and accumulated data are de- tailing the features and the effects of the new coronavirus disease 19 (COVID 19) in the adult population, and cardiovascular involvement is emerging as the most significant and life-threatening complication, with an in- creased risk of morbidity and mortality in patients with underlying cardiovascular disease. At present, though the limited data on the effects of COVID 19 in pediatric patients, children seem to count for a little proportion of SARS-COV 2 infection, and present with less severe disease and effects However infants and toddlers are at risk of developing critical course. The disease has a range of clinical presentations in children, for which the potential need for further investigation of myocardial injury and cardiovascular issues should be kept in mind to avoid misdiagnosing severe clinical entities. Overlapping with Kawasaki disease is a concern, particularly the incomplete and atypical form. We aim to summarize the initial considerations and potential cardiovascular implications of COVID-19 for children and patients with congenital heart disease.
References
Zheng YY, Ma YT, Zhang JY, Xie X. COVID-19 and the cardiovascular system. Nat Rev Cardiol. 2020;17(5):259–260.
Driggin E, Madhavan MV, Bikdeli B, et al. Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the Coronavirus Disease 2019 (COVID-19) Pandemic [published online ahead of print, 2020 Mar 18]. J Am Coll Cardiol. 2020;
Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China [published online ahead of print, 2020 Mar 3] [published correction appears in Intensive Care Med. 2020 Apr 6;]. Intensive Care Med. 2020;1–3
Yu CM, Wong RS, Wu EB, Kong SL, Wong J, Yip GW, Soo YO, Chiu ML, Chan YS, Hui D, Lee N, Wu A, Leung CB, Sung JJ. Cardiovascular complications of severe acute respiratory syndrome. Postgrad Med J. 2006 Feb;82(964):140-4.
Rao S, Sasser W, Diaz F, Sharma N, Alten J. Coronavirus Associated Fulminant Myocarditis Successfully Treated with Intravenous Immunoglobulin and Extracorporeal Membrane Oxygenation. Chest. 2014 Oct;146(4):336A.
Alhogbani, T. Acute myocarditis associated with novel Middle East respiratory syndrome coronavirus. Ann. Saudi Med. 36, 78–80(2016).
Tan W, Aboulhosn J. The cardiovascular burden of coronavirus disease 2019 (COVID-19) with a focus on congenital heart disease [published online ahead of print, 2020 Mar 28]. Int J Cardiol. 2020
Jia HP, Look DC, Shi L, et al. ACE2 receptor expression and severe acute respiratory syndrome coronavirus infection depend on differentiation of human airway epithelia. J Virol. 2005;79(23):14614–14621
Oudit GY, Kassiri Z, Jiang C, et al. SARS-coronavirus modulation of myocardial ACE2 expression and inflammation in patients with SARS. Eur J Clin Invest. 2009;39(7):618–625
Wan Y, Shang J, Graham R, Baric RS, Li F. Receptor Recognition by the Novel Coronavirus from Wuhan: an analysis Based on Decade-Long Structural Studies of SARS Coronavirus. J Virol. 2020;94(7): e00127-20
Zhang H, Penninger JM, Li Y, Zhong N, Slutsky AS. Angiotensin-converting enzyme 2 (ACE2) as a SARS-CoV-2 receptor: molecular mechanisms and potential therapeutic target. Intensive Care Med. 2020;46(4):586–590
Wong CK, Lam CW, Wu AK, et al. Plasma inflammatory cytokines and chemokines in severe acute respiratory syndrome. Clin Exp Immunol. 2004;136(1):95–103
Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China [published correction appears in Lancet. 2020 Jan 30;:]. Lancet. 2020;395(10223):497–506.
Xu Z, Shi L, Wang Y, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome [published correction appears in Lancet Respir Med. 2020 Feb 25;]. Lancet Respir Med. 2020;8(4):420–422
Zhu H, Rhee JW, Cheng P, et al. Cardiovascular Complications in Patients with COVID-19: Consequences of Viral Toxicities and Host Immune Response. Curr Cardiol Rep. 2020;22(5):32
Yang C, Jin Z. An Acute Respiratory Infection Runs into the Most Common Noncommunicable Epidemic-COVID-19 and Cardiovascular Diseases [published online ahead of print, 2020 Mar 25]. JAMA Cardiol. 2020;10.
Li B, Yang J, Zhao F, et al. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clin Res Cardiol. 2020
Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study [published online ahead of print, 2020 Feb 24] [published correction appears in Lancet Respir Med. 2020 Apr;8(4): e26]. Lancet Respir Med. 2020;
Guan WJ, Ni ZY, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China [published online ahead of print, 2020 Feb 28]. N Engl J Med. 2020;
Zeng JH, Liu YX, Yuan J, et al. First case of COVID-19 complicated with fulminant myocarditis: a case report and insights [published online ahead of print, 2020 Apr 10]. Infection
Inciardi RM, Lupi L, Zaccone G, et al. Cardiac Involvement in a Patient with Coronavirus Disease 2019 (COVID-19) [published online ahead of print, 2020 Mar 27]. JAMA Cardiol. 2020;
Chen C, Zhou Y, Wang DW. SARS-CoV-2: a potential novel etiology of fulminant myocarditis [published online ahead of print, 2020 Mar 5]. Herz. 2020
Hu H, Ma F, Wei X, Fang Y. Coronavirus fulminant myocarditis saved with glucocorticoid and human immunoglobulin [published online ahead of print, 2020 Mar 16]. Eur Heart J. 2020
Varga Z, Flammer AJ, Steiger P, et al. Endothelial cell infection and endotheliitis in COVID-19 [published online ahead of print, 2020 Apr 20]. Lancet. 2020
Shi S, Qin M, Shen B, et al. Association of Cardiac Injury with Mortality in Hospitalized Patients With COVID-19 in Wuhan, China [published online ahead of print, 2020 Mar 25]. JAMA Cardiol. 2020
Zhou B, She J, Wang Y, Ma X. The clinical characteristics of myocardial injury in severe and very severe patients with 2019 novel coronavirus disease [published online ahead of print, 2020 Mar 21]. J Infect. 2020
Lippi G, Lavie CJ, Sanchis-Gomar F. Cardiac troponin I in patients with coronavirus disease 2019 (COVID-19): Evidence from a meta-analysis [published online ahead of print, 2020 Mar 10]. Prog Cardiovasc Dis. 2020
Vetter P, Vu DL, L'Huillier AG, Schibler M, Kaiser L, Jacquerioz F. Clinical features of covid-19. BMJ. 2020
World Health Organization. WHO interim guidance on clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected. 2020. www.who.org
Centers for Disease Control and Prevention. Interim clinical guidance for management of patients with confirmed 2019 novel coronavirus (2019-nCoV) infection. www.cdc.gov
Elfiky AA. Anti-HCV, nucleotide inhibitors, repurposing against COVID-19. Life Sci. 2020 248:117477
Recent progress and challenges in drug development against COVID-19 coronavirus (SARS-CoV-2) - an update on the status [published online ahead of print, 2020 Apr 19]. Infect Genet Evol. 2020;83
Dong L, Hu S, Gao J. Discovering drugs to treat coronavirus disease 2019 (COVID-19). Drug Discov Ther. 2020;14(1):58–60
Wu CI, Postema PG, Arbelo E, et al. SARS-CoV-2, COVID-19 and inherited arrhythmia syndromes [published online ahead of print, 2020 Mar 31]. Heart Rhythm. 2020; S1547-5271(20)30285-X
Long B, Brady WJ, Koyfman A, Gottlieb M. Cardiovascular complications in COVID-19 [published online ahead of print, 2020 Apr 18]. Am J Emerg Med. 2020
Kochi AN, Tagliari AP, Forleo GB, Fassini GM, Tondo C. Cardiac and arrhythmic complications in patients with COVID-19 [published online ahead of print, 2020 Apr 9]. J Cardiovasc Electrophysiol. 2020
Dong Y, Mo X, Hu Y, et al. Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China. Pediatrics. 2020
Wu Z, McGoogan JM. Characteristics of and Important Lessons from the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases from the Chinese Center for Disease Control and Prevention [published online ahead of print, 2020 Feb 24]. JAMA.
Livingston E, Bucher K. Coronavirus Disease 2019 (COVID-19) in Italy [published online ahead of print, 2020 Mar 17]. JAMA. 2020
Lu X, Zhang L, Du H, et al. SARS-CoV-2 Infection in Children. N Engl J Med. 2020;382(17):1663–1665
Korean Society of Infectious Diseases; Korean Society of Pediatric Infectious Diseases; Korean Society of Epidemiology; Korean Society for Antimicrobial Therapy; Korean Society for Healthcare-associated Infection Control and Prevention; Korea Centers for Disease Control and Prevention. Report on the Epidemiological Features of Coronavirus Disease 2019 (COVID-19) Outbreak in the Republic of Korea from January 19 to March 2, 2020. J Korean Med Sci. 2020;35(10):e112
Wei M, Yuan J, Liu Y, Fu T, Yu X, Zhang ZJ. Novel Coronavirus Infection in Hospitalized Infants Under 1 Year of Age in China [published online ahead of print, 2020 Feb 14]. JAMA. 2020;323(13):1313–1314
Zimmermann P, Curtis N. Coronavirus Infections in Children Including COVID-19: An Overview of the Epidemiology, Clinical Features, Diagnosis, Treatment and Prevention Options in Children. Pediatr Infect Dis J. 2020;39(5):355–368
Chen ZM, Fu JF, Shu Q, et al. Diagnosis and treatment recommendations for pediatric respiratory infection caused by the 2019 novel coronavirus [published online ahead of print, 2020 Feb 5]. World J Pediatr. 2020
Ong JSM, Tosoni A, Kim Y, Kissoon N, Murthy S. Coronavirus Disease 2019 in Critically Ill Children: A Narrative Review of the Literature [published online ahead of print, 2020 Apr 7]. Pediatr Crit Care Med. 2020
Choi SH, Kim HW, Kang JM, Kim DH, Cho EY. Epidemiology and clinical features of coronavirus disease 2019 in children. Clin Exp Pediatr. 2020;63(4):125–132. doi:10.3345/cep.2020.00535
Morand A, Fabre A, Minodier P, et al. COVID-19 virus and children: What do we know? Arch Pediatr. 2020
Xia W, Shao J, Guo Y, Peng X, Li Z, Hu D. Clinical and CT features in pediatric patients with COVID-19 infection: Different points from adults. Pediatr Pulmonol. 2020;55(5):1169–1174
Caforio AL, Pankuweit S, Arbustini E, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J. 2013;34(33):2636–2648d
Dasgupta S, Iannucci G, Mao C, Clabby M, Oster ME. Myocarditis in the pediatric population: A review. Congenit Heart Dis. 2019;14(5):868–877
Tunuguntla H, Jeewa A, Denfield SW. Acute Myocarditis and Pericarditis in Children. Pediatr Rev. 2019;40(1):14–25
Management of Kawasaki Disease: A Scientific Statement for Health Professionals from the American Heart Association [published correction appears in Circulation. 2019 Jul 30;140(5): e181-e184]. Circulation. 2017;135(17): e927–e999
Marchesi A, Tarissi de Jacobis I, Rigante D, et al. Kawasaki disease: guidelines of the Italian Society of Pediatrics, part I - definition, epidemiology, etiopathogenesis, clinical expression and management of the acute phase. Ital J Pediatr. 2018;44(1):102
Holm JM, Hansen LK, Oxhøj H. Kawasaki disease associated with parvovirus B19 infection. Eur J Pediatr. 1995;154(8):633–634
Jordan-Villegas A, Chang ML, Ramilo O, Mejías A. Concomitant respiratory viral infections in children with Kawasaki disease. Pediatr Infect Dis J. 2010;29(8):770–772
Kim JH, Yu JJ, Lee J, et al. Detection rate and clinical impact of respiratory viruses in children with Kawasaki disease. Korean J Pediatr. 2012;55(12):470–473.
Turnier JL, Anderson MS, Heizer HR, Jone PN, Glodé MP, Dominguez SR. Concurrent Respiratory Viruses and Kawasaki Disease. Pediatrics. 2015;136(3): e609–e614
CDC COVID-19 Response Team. Coronavirus Disease 2019 in Children - United States, February 12-April 2, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(14):422–426
CDC COVID-19 Response Team. Preliminary Estimates of the Prevalence of Selected Underlying Health Conditions Among Patients with Coronavirus Disease 2019 - United States, February 12-March 28, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(13):382–386
Covid-19 and patients with congenital heart disease. Indications and suggestions from the Italian Society of Pediatric Cardiology and Congenital Heart Diseases. By the Board of the Italian Society of Pediatric Cardiology and Congenital Heart Diseases www.sicped.it
Imai Y, Kuba K, Rao S, et al. Angiotensin-converting enzyme 2 protects from severe acute lung failure. Nature. 2005;436(7047):112–116.
Gurwitz D. Angiotensin receptor blockers as tentative SARS-CoV-2 therapeutics [published online ahead of print, 2020 Mar 4]. Drug Dev Res. 2020
Downloads
Published
Issue
Section
License
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Transfer of Copyright and Permission to Reproduce Parts of Published Papers.
Authors retain the copyright for their published work. No formal permission will be required to reproduce parts (tables or illustrations) of published papers, provided the source is quoted appropriately and reproduction has no commercial intent. Reproductions with commercial intent will require written permission and payment of royalties.
How to Cite
