The Electrocardiogram in the Differential Diagnosis of Cardiologic Conditions Related to the COVID-19 Pandemic

Bruna  Predabon; Arthur Zanfrilli Marques  Souza; Gustavo Henrique Sumnienski Bertoldi; Rafaela Louise  Sales; Karila Scarduelli  Luciano; Rafael de March  Ronsoni

Authors

Bruna Predabon Universidade da Região de Joinville – Departmento de Medicina – Joinville (SC), Brazil.
Arthur Zanfrilli Marques Souza Universidade da Região de Joinville – Departmento de Medicina – Joinville (SC), Brazil.
Gustavo Henrique Sumnienski Bertoldi Universidade da Região de Joinville – Departmento de Medicina – Joinville (SC), Brazil https://orcid.org/0000-0001-6347-3137
Rafaela Louise Sales Hospital Regional Hans Dieter Schmidt – Departmento de Cardiologia – Joinville (SC), Brazil.
Karila Scarduelli Luciano Hospital Regional Hans Dieter Schmidt – Departmento de Cardiologia – Joinville (SC), Brazil.
Rafael de March Ronsoni Universidade da Região de Joinville – Departmento de Medicina – Joinville (SC), Brazil and Hospital Regional Hans Dieter Schmidt – Departmento de Cardiologia – Joinville (SC), Brazil.

Keywords:

Myocarditis, COVID-19, Electrocardiographic

Abstract

The World Health Organization (WHO) declared Sars-CoV infection and COVID-19 as a pandemic and global emergency. In addition to viral pneumonia and the severe acute respiratory syndrome (Sars), the heart is affected in some patients due to the detection of biomarkers and reported cases of myocarditis and pericarditis. Therefore, the knowledge of electrocardiogram presentation of these actual infections can guide the choice for the best treatment and can help to reduce misdiagnosis, mainly the acute myocardial infarction, which is the main differential diagnosis.

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References

Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet [Internet]. 2020 Feb;395(10223):497–506. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0140673620301835

Xu J, Zhao S, Teng T, Abdalla AE, Zhu W, Xie L, et al. Systematic Comparison of Two Animal-to-Human Transmitted Human Coronaviruses: SARS-CoV-2 and SARS-CoV. Viruses [Internet]. 2020 Feb 22;12(2):244. Available from: https://www.mdpi.com/1999-4915/12/2/244

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. Gallagher T, editor. J Virol [Internet]. 2020 Jan 29;94(7). Available from: http://jvi.asm.org/lookup/doi/10.1128/JVI.00127-20

Sun P, Qie S, Liu Z, Ren J, Li K, Xi J. Clinical characteristics of 50 466 hospitalized patients with 2019‐nCoV infection. J Med Virol [Internet]. 2020 Mar 11;jmv.25735. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1002/jmv.25735

Chen C, Zhou Y, Wang DW. SARS-CoV-2: a potential novel etiology of fulminant myocarditis. Herz [Internet]. 2020 Mar 5; Available from: http://link.springer.com/10.1007/s00059-020-04909-z

Shi S, Qin M, Shen B, Cai Y, Liu T, Yang F, et al. Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. JAMA Cardiol [Internet]. 2020 Mar 25; Available from: https://jamanetwork.com/journals/jamacardiology/fullarticle/2763524

Inciardi RM, Lupi L, Zaccone G, Italia L, Raffo M, Tomasoni D, et al. Cardiac Involvement in a Patient With Coronavirus Disease 2019 (COVID-19). JAMA Cardiol [Internet]. 2020 Mar 27; Available from: https://jamanetwork.com/journals/jamacardiology/fullarticle/2763843

Zeng, J.H.; Liu, Y.; Yuan, J.; Wang, F.; Wu, W.; Li, J.; Wang, L.; Gao, H.; Wang, Y.; Dong, C.; Li, Y.; Xie, X.; Feng, C.; Liu L. First Case of COVID-19 Infection with Fulminant Myocarditis Complication: Case Report and Insights. Preprints. 2020;

Hua A, O’Gallagher K, Sado D, Byrne J. Life-threatening cardiac tamponade complicating myo-pericarditis in COVID-19. Eur Heart J [Internet]. 2020 Mar 30; Available from: https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehaa253/5813280

Celik T, Ozturk C, Balta S, Iyisoy A. The role of combined electrocardiogram criteria in differential diagnosis of acute pericarditis: PR segment and QT interval. Am J Emerg Med [Internet]. 2016 Jul;34(7):1309. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0735675716300377

Buttà C, Zappia L, Laterra G, Roberto M. Diagnostic and prognostic role of electrocardiogram in acute myocarditis: A comprehensive review. Ann Noninvasive Electrocardiol [Internet]. 2019 Nov 28;anec.12726. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/anec.12726

Pollak P, Brady W. Electrocardiographic Patterns Mimicking ST Segment Elevation Myocardial Infarction. Cardiol Clin [Internet]. 2012 Nov;30(4):601–15. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0733865112000926

Spodick DH, Spodick DH. Diagnostic Electrocardiographic Sequences in Acute Pericarditis Significance of PR Segment and PR Vector Changes [Internet]. [cited 2020 Apr 8]. Available from: http://ahajournals.org

Lu MLR, De Venecia T, Patnaik S, Figueredo VM. Atrial myocardial infarction: A tale of the forgotten chamber. Int J Cardiol [Internet]. 2016 Jan;202:904–9. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0167527315306343

Spodick DH. Electrocardiogram in acute pericarditis. Am J Cardiol [Internet]. 1974 Apr [cited 2020 Apr 8];33(4):470–4. Available from: https://linkinghub.elsevier.com/retrieve/pii/0002914974906031

Patton KK, Ellinor PT, Ezekowitz M, Kowey P, Lubitz SA, Perez M, et al. Electrocardiographic Early Repolarization: A Scientific Statement from the American Heart Association. Circulation [Internet]. 2016 Apr 12 [cited 2020 Apr 4];133(15):1520–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27067089

Birnbaum Y, Perez Riera AR, Nikus K. PR depression with multi‑lead ST elevation and ST depression in aVR: Is it always acute pericarditis? J Electrocardiol [Internet]. 2019 May;54:13–7. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0022073618307520

Spodick DH. Differential Characteristics of the Electrocardiogram in Early Repolarization and Acute Pericarditis. N Engl J Med [Internet]. 1976 Sep 2 [cited 2020 Apr 4];295(10):523–6. Available from: http://www.nejm.org/doi/abs/10.1056/NEJM197609022951002

Lu MLR, Nwakile C, Bhalla V, De Venecia T, Shah M, Figueredo VM. Prognostic significance of abnormal P wave morphology and PR-segment displacement after ST-elevation myocardial infarction. Int J Cardiol [Internet]. 2015 Oct;197:216–21. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0167527315013571

Zhan Z, Nikus K, Birnbaum Y. PR depression with multilead ST elevation and ST depression in aVR by left circumflex artery occlusion: How to differentiate from acute pericarditis. Ann Noninvasive Electrocardiol [Internet]. 2020 Feb 21; Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/anec.12752

Lindow T, Pahlm O, Khoshnood A, Nyman I, Manna D, Engblom H, et al. Electrocardiographic changes in the differentiation of ischemic and non-ischemic ST elevation. Scand Cardiovasc J [Internet]. 2020 Mar 3;54(2):100–7. Available from: https://www.tandfonline.com/doi/full/10.1080/14017431.2019.1705383

Jim M-H, Siu C-W, Chan AO-O, Chan RH-W, Lee SW-L, Lau C-P. Prognostic implications of PR-segment depression in inferior leads in acute inferior myocardial infarction. Clin Cardiol [Internet]. 2006 Aug;29(8):363–8. Available from: http://doi.wiley.com/10.1002/clc.4960290809

Zorzi A, Baritussio A, ElMaghawry M, Siciliano M, Migliore F, Perazzolo Marra M, et al. Differential diagnosis at admission between Takotsubo cardiomyopathy and acute apical-anterior myocardial infarction in postmenopausal women. Eur Hear J Acute Cardiovasc Care [Internet]. 2016 Aug 11;5(4):298–307. Available from: http://journals.sagepub.com/doi/10.1177/2048872615585515

Porela P, Kytö V, Nikus K, Eskola M, Airaksinen KEJ. PR Depression Is Useful in the Differential Diagnosis of Myopericarditis and ST Elevation Myocardial Infarction. Ann Noninvasive Electrocardiol [Internet]. 2012 Apr [cited 2020 Apr 4];17(2):141–5. Available from: http://doi.wiley.com/10.1111/j.1542-474X.2012.00489.x

Adler C, Halbach M, Adler J, Michels G, Reuter H. Differenzialdiagnostische Bedeutung der PR-Strecke in der EKG-Interpretation. Medizinische Klin - Intensivmed und Notfallmedizin [Internet]. 2018 Feb 23;113(1):50–2. Available from: http://link.springer.com/10.1007/s00063-017-0364-z

Rossello X, Wiegerinck RF, Alguersuari J, Bardají A, Worner F, Sutil M, et al. New Electrocardiographic Criteria to Differentiate Acute Pericarditis and Myocardial Infarction. Am J Med [Internet]. 2014 Mar [cited 2020 Apr 5];127(3):233–9. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0002934313009753

Lee DH, Walsh B, Smith SW. Terminal QRS distortion is present in anterior myocardial infarction but absent in early repolarization. Am J Emerg Med [Internet]. 2016 Nov 1 [cited 2020 Apr 5];34(11):2182–5. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0735675716305459

Makaryus JN, Makaryus AN, Boal B. Spodick’s Sign. Am J Med [Internet]. 2008 Aug;121(8):693–4. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0002934308000600

Chaubey V. Spodick’s Sign: A Helpful Electrocardiographic Clue to the Diagnosis of Acute Pericarditis. Perm J [Internet]. 2014 Mar 17;e122–e122. Available from: http://www.thepermanentejournal.org/issues/2014/winter/5637-letter-acute-pericarditis.html