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Review
. 2022 Dec 30;13(1):120.
doi: 10.3390/diagnostics13010120.

Cardiac Involvement in Children Affected by COVID-19: Clinical Features and Diagnosis

Affiliations
Review

Cardiac Involvement in Children Affected by COVID-19: Clinical Features and Diagnosis

Elena Vasichkina et al. Diagnostics (Basel). .

Abstract

COVID-19 (Coronavirus disease 2019) in children is usually mild. However, multiple organ disorders associated with SARS-CoV-2 (severe acute respiratory syndrome-related coronavirus 2) have been detected with poor respiratory symptoms. Cardiac changes are noted in 17% to 75% of cases, which are associated with diagnostic difficulties in high-risk groups for the development of complications that are associated with myocardial damage by the SARS-CoV-2 virus. The objective of this review is to identify the most significant symptoms of cardiac involvement affected by COVID-19, which require in-depth examination. The authors analyzed publications from December 2019 to the October 2022, which were published in accessible local and international databases. According to the analysis data, the main sign of myocardial involvement was increasing as cardiomarkers in the patient's blood, in particular troponin I or troponin T. Many authors noted that the increased level of CRP (C-reactive protein) and NT-proBNP, which are accompanied by changes in the ECG (electrocardiogram) and EchoCG (echocardiography), as a rule, were nonspecific. However, the identified cardiac functional dysfunctions affected by SARS-CoV-2, required an cardiac MRI. The lack of timely diagnosis of myocardial involvements, especially in children at high risk for the development of complications associated with SARS-CoV-2 myocardial injury, can lead to death. The direct damage of the structural elements of myocardial blood vessels in patients with severe hypoxic changes resulted from respiratory failure caused by SARS-CoV-2 lung damage, with the development of severe acute diffuse alveolar damage and cell-mediated immune response and myocardial involvement affected by SARS-CoV-2 damage. In this article, the authors introduce a clinical case of a child who dead from inflammatory myocardities with COVID-19 in a background of congenital heart disease and T-cell immunodeficiency.

Keywords: COVID-19; Myocarditis; SARS-CoV-2; cardiovascular inflammation; children; coronavirus infection.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Heart changes in a 2-year-old child who died from COVID-19 (this is an original figure). Focal acute polymorphic cell myocarditis, pathological changes in intramural blood vessels, and expression of SARS-CoV2 spike antigen (brown arrow) by endothelial and smooth muscle cells of myocardial blood vessels. (A)—H&E, (B)—IHH, mouse monoclonal anti-CD45 (Thermo, USA); (C)—IHH, mouse monoclonal anti-CD31 (Thermo, USA); (DF)—IHH, rabbit polyclonal anti-SARS-CoV-2 Spike (GeneTex, USA), (A,B,D). The length of the scale segment (A)—200 μm, (B,C)—100 μm; (DF)—100 µm.
Figure 2
Figure 2
The pathogenesis of SARS-CoV-2 and its main morphological manifestations in myocardial damage. ACE2, angiotensin-converting enzyme 2; BNP, brain natriuretic peptide 32; CRP, C-reactive protein; IL-6, interleukin-6; SARS-CoV-2, severe acute respiratory syndrome-related coronavirus 2; TMPRSS2, transmembrane serine protease 2. ↑ level decrease; ↓, level increase.

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