Role of a Pediatric Cardiologist in the COVID-19 Pandemic

Abstract

Coronavirus disease 2019 (COVID-19) has affected patients across all age groups, with a wide range of illness severity from asymptomatic carriers to severe multi-organ dysfunction and death. Although early reports have shown that younger age groups experience less severe disease than older adults, our understanding of this phenomenon is in continuous evolution. Recently, a severe multisystem inflammatory syndrome in children (MIS-C), with active or recent COVID-19 infection, has been increasingly reported. Children with MIS-C may demonstrate signs and symptoms of Kawasaki disease, but also have some distinct differences. These children have more frequent and severe gastrointestinal symptoms and are more likely to present with a shock-like presentation. Moreover, they often present with cardiovascular involvement including myocardial dysfunction, valvulitis, and coronary artery dilation or aneurysms. Here, we present a review of the literature and summary of our current understanding of cardiovascular involvement in children with COVID-19 or MIS-C and identifying the role of a pediatric cardiologist in caring for these patients.

Keywords: COVID-19; Cardiovascular; MIS-C; Pediatric.

Fig. 1

Approach in children with COVID-19 and MIS-C with red flags for pediatric cardiology referral

Fig. 2

Electrocardiographic abnormalities in children with COVID-19 and MIS-C. a Low-voltage QRS complex in a patient with myocarditis. b Complete heart block in a patient with myocarditis. c ST segment changes in anterior leads suggestive of anterior infarction in a patient with giant coronary artery aneurysms and thrombosis

Fig. 3

Echocardiographic abnormalities in children with COVID-19 and MIS-C. a Parasternal short axis view at the level of aortic valve demonstrating diffuse dilation of right coronary artery (RCA) and coronary artery walls are echogenic. b Apical 4 chamber view demonstrating mitral valve regurgitation. c Parasternal short axis view at the level of mitral valve showing tiny posterior pericardial effusion in a patient with myocarditis. d M-mode demonstrating decreased systolic function. e Apical 4 chamber view demonstrating severe left ventricular (LV) dilation due to myocardial dysfunction