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Evaluation of Cardiac Complications in Pateint Undergoing COVID 19 Treatment: An Original Research

Dr. Sunil Kumar Gulia1, Dr Rahul Kashyap2, Dr. RishabhThakker3, Dr.

AnkitChowdhry4,Dr. MyleshRavisankarDakshinamurthy5, Dr. SarineDergarapet6,Dr.

HeenaTiwari7

1Senior Lecturer, Oral and maxillofacial Surgery, SGT University, Gurugram, Badli, Jhajjar, [email protected]

2Professor, Dept. of Oral & Maxillofacial Surgery, I.T.S. Centre for Dental Studies &

Research, NH-58 Delhi-Meerut Road Ghaziabad. Uttar Pradesh. [email protected]

3Resident, Department of Oral and Maxillofacial Surgery, SGT [email protected]

4Resident, Department of Oral and Maxillofacial Surgery, SGT [email protected]

54th year MBBS student at Yerevan State Medical University, Yerevan, [email protected]

6Medical Coder, Clinchoice, Yerevan, [email protected]

7BDS, PGDHHM, MPH Student, ParulUniveristy, Limda, Waghodia, Vadodara, Gujrat, [email protected]

Corresponding Author:

Dr. Sunil Kumar Gulia, Senior Lecturer, Oral and maxillofacial Surgery, SGTUniversity, Gurugram, Badli, Jhajjar, [email protected]

ABSTRACT

Introduction: Cardiac arrhythmias are important causes of death among populations and are always responsible for a high percentage of mortality in hospitalized patients. The aim of this descriptive analytical study was to evaluate the frequency of arrhythmias in patients with coronavirus disease 2019 (COVID-19)

Material and methods: All the COVID-19 patients with a cardiac condition admitted to the intensive care unit were enrolled in the study by census. Electrocardiography (ECG) and Holter monitoring were used to diagnose arrhythmias. Data analysis was performed using descriptive statistics (frequency and percentage).

Results: The total number of eligible patients was 45, of whom 26 (57.8%) were men and 19 (42.2%) were women. The mortality rate of arrhythmias among COVID-19 patients was 17.77% (8 out of 45 patients), and the recovery rate was 82.13% (37 out of 45 patients).

Tachycardia and a lack of response to heart-rate-reducing drugs were observed in patients with COVID-19.

Conclusion: Owing to an overlap between these symptoms and those of heart diseases, there is a need to further evaluate patients with arrhythmias. Although arrhythmias are not common in COVID-19 patients, they can be fatal and have a high mortality rate, which can be prevented by early detection.

Key words: Cardiac Arrhythmias, Covid-19, Coronavirus.

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INTRODUCTION

Coronavirus disease 2019 (COVID-19) has become a global problem in recent months, spreading to more than 150 countries in a globe pandemic [1]. In a study by Ruan et al., the mortality rate of individuals with COVID-19 significantly increased in the presence of cardiovascular abnormalities [2]. Another study noted that underlying diseases such as hypertension can increase the mortality rate up to 2.5 times [3]. Although the clinical manifestations of COVID-19 in patients with cardiac failure are unknown, the clinical features of patients with end-stage heart disease indicate cardiac injury by the virus [4–6].

Manifestations of COVID-19 are also linked to demographic parameters. The highest mortality is found in older men with a mean age of 75 years, who also present with histories of underlying conditions such as diabetes, hypertension, heart problems, chronic respiratory disease, cancer and previous surgery. COVID-19 exaggerates cardiovascular complications by promoting arterial and venous thrombosis through inducing inflammation, activating platelets and causing vascular dysfunction and blockade. Because of this, antithrombotic drugs are recommended to be prescribed in these patients [7].

In addition to promoting inflammatory responses and myocardial injury, COVID-19 also augments the risk of acute coronary artery syndrome, heart failure and arrhythmias [8].

Cardiac arrhythmias are the most threatening complications of heart diseases and cause the deaths of a large number of patients. The aim of this study was to investigate the frequency of arrhythmias in patients with COVID-19.

MATERIALS AND METHODS

In this descriptive analytical study, all patients with COVID-19 and a cardiac condition admitted to the intensive care unit during March to August 2020 were enrolled by census. A definite diagnosis of COVID-19 by PCR was applied as an in- clusion criterion.

Electrocardiography (ECG) and Holter monitoring were used to diagnose cardiac status. Data analysis was performed in Microsoft EXCEL applying descriptive statistics (frequency and percentage).

RESULTS

In total, 45 eligible patients were enrolled, of whom 26 (57.8%) were men, and 19 (42.2%)were women. Twelve people (26.7%) were <60 years old, 23 (51.1%) were between 60 and 70 years old, and 10 (22.3%) were>70 years old. Of these patients, 40 (88.9%) had a history of hospitalization before admission. The criterion for being hospitalized was a positive PCR test. After the diagnosis of COVID-19 based on clinical symptoms, treatment and supportive care were started, and after confirmation by PCR (which generally takes around 48–72 hours), the patient was subjected to major therapeutic measures. The medications used for these patients included ciprofloxacin, vancomycin, ceftriaxone, dexamethasone, recigen and remdesivir, according to clinical signs and symptoms. The genotype of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during this period was D614G.Table 1 demonstrates the frequencies of different types of arrhythmias

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patients, one of whom was diagnosed with VT, and the other two with sinus tachycardia.

Table 2 shows the frequency of death in COVID-19 patients with arrhythmia and non- arrhythmia disorders. Fig. 1 shows the prevalence of AF and PVC arrhythmias in each gender.

TABLE 1. THE FREQUENCY OF ARRHYTHMIAS IN PATIENTS WITH CORONAVIRUS DISEASE 2019

ECG findings Type n %

Arrhythmia PAC 2 4.44

PVC 9 20

AF 9 20

PSVT 2 4.44

VT 2 4.44

VF 1 2.22

AV Block 1 2.22

Non-arrhythmia BBB 10 22.22

Bradycardia 3 6.66

Tachycardia 11 24.44

Abbreviations: AF, atrial fibrillation; BBB, bundle branch block; PAC, premature atrial contraction; PVC, premature ventricular contraction; PSVT, paroxysmal supraventricular tachycardia; VF, ventricular fibrillation; VT, ventricular tachycardia.

TABLE 2. COMPARISON OF THE RATES OF RECOVERY AND MORTALITY BETWEEN CORONAVIRUS DISEASE 2019 PATIENTS WITH ARRHYTHMIA AND NON- ARRHYTHMIA PROBLEMS

Total Deceased Recovered

COVID-19 patients with cardiac abnormality

n % n % n %

Arrhythmia 45 1 8 7.62 37 1

Non-arrhythmia 4653 99 97 92.38 3963 99

Total 4698 100 105 100 4000 100

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FIG. 1.ATRIAL fiBRILLATION (AF) AND PREMATURE VENTRICULAR CONTRACTION (PVC) ARRHYTHMIAS IN MEN AND WOMEN WITH CORONAVIRUS DISEASE 2019.

DISCUSSION

The aim of this study was to investigate the frequency of ECG abnormalities (arrhythmias and non-arrhythmias) in COVID-19 patients. Our results showed that arrhythmias were identified in 45 COVID-19 patients diagnosed over a period of 3 months. This comprised about 1% of all patients diagnosed during this period. This observation was in line with the finding of Wang et al., who noted an association between the SARS-CoV-2 infection and inflammatory mediators that may play important roles in the path physiology of cardiac events and arrhythmias. In one study, the rate of heart damage was 1% in around 19% of the patients diagnosed with COVID-19, and this event was associated with a higher risk of in- hospital mortality [9].The mortality rate of arrhythmias in COVID-19 patients was 17.77%, and the recovery rate was 82.13%. Although acute lung injury is a common problem in patients with COVID-19, which leads to significant morbidity and mortality, clinical and epidemiological evidence suggests that SARS-CoV-2 infection is also associated with myocardial damage and arrhythmias [2].According to Mandeep et al., in a study of cardiovascular risk factors in patients with heart conditions, 30.5%, 26.3%, 14.3%, 16.8%

and 5.5% of the patients reported hyperlipidaemia, hypertension, diabetes, a history of smoking and current smoking, respectively [10]. In the recent study, cardiovascular diseases included coronary artery disease (11.3%), congestive heart failure (2.1%) and cardiac arrhythmia (3.4%). The patients’ average length of hospital stay was between 8 and 12 days, and the overall in-hospital mortality rates were 5.8% in total (515 out of 8910 patients) and 24.7% for the patients hospitalized in the intensive care unit [2]. The most common arrhythmias in the deceased patients were AF, VF and VT, respectively. This was in line with the study of Pietro et al., who asserted that the virus-induced aberrant function of the immune system increased the risk of arrhythmic events, including severe ventricular arrhythmias [11].

We noticed that the mortality rate was higher among men than women. Along with age and gender, many other complications and parameters have been associated with severity and

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possible SARS-CoV-2 infection in patients with arrhythmic symptoms.

LIMITATIONS

The low power of the study was one of our limitations, which was due to the relatively small number of COVID-19 patients in the province.

CONCLUSION

Although arrhythmias are not common in COVID-19 patients, they have a high mortality rate, necessitating early diagnostic and therapeutic interventions.

REFERENCES

1. Arnold SLM, Buckner F. Hydroxychloroquine for treatment of SARS- CoV-2 infection?

Improving our confidence in a model-based approach to dose selection. ClinTranslSci 2020;13:642–5.

2. Ruan Q, Yang K, Wang W, Jiang L, Song J. Correction to: clinical predictors of mortality due to COVID-19 based on an analysis of dataof 150 patients from Wuhan, China. Intensive Care Med 2020;46:1294–7.

3. Lippi G, Wong J, Henry BM. Hypertension and its severity or mortality in Coronavirus Disease 2019 (COVID-19): a pooled analysis. Pol Arch Intern Med 2020;130:304–9.

4. Bansal M. Cardiovascular disease and COVID-19. Diabetes MetabSynd 2020;14:247–

50.

5. Dong N, Cai J, Zhou Y, Liu J, Li F. End-stage heart failure with COVID- 19: strong evidence of myocardial injury by 2019-nCoV. JACC Heart Fail 2020;8:515–7.

6. Hulot J-S. COVID-19 in patients with cardiovasculardiseases. ArchCardiovasc Dis 2020;113:225–6.

7. Bikdeli B, Madhavan MV, Jimenez D, Chuich T, Dreyfus I, Driggin E, et al. COVID-19 and thrombotic or thromboembolic disease: impli-cations for prevention, antithrombotic therapy, and follow-up. J AmCollCardiol 2020;75:2950–73.

8. Tam C-CF, Cheung K-S, Lam S, Wong A, Yung A, Sze M, et al. Impact of coronavirus disease 2019 (COVID-19) outbreak on ST-segment– elevation myocardial infarction care in Hong Kong, China. Circ Car-diovasQual Outcome 2020 Apr;13(4):e006631.

9. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical charac-teristics of 138 hospitalized patients with 2019 novel coronavirus- infected pneumonia in Wuhan, China.

JAMA 2020;323:1061–9.

10. Mehra MR, Desai SS, Kuy SR, Henry TD, Patel AN. Cardiovascular disease, drug therapy, and mortality in COVID-19. N Engl J Med 2020;382:e102.

11. Pietro EL, Mohamed B, Pier LC. COVID-19, arrhythmic risk and inflammation.

Circulation 2020;142:7–9.

12. Jin J-M, Peng B, Wei H, Wu F, Liu X-F, Han D-M, et al. Gender dif-ferences in patients with COVID-19: focus on severity and mortality. Front Publ Health 2020;8:152.

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