Cardiac Manifestations of COVID-19 Associated MIS-C

Multisystem Inflammatory Syndrome in Children (MIS-C) is a serious and potentially life-threatening illness exhibited in COVID-19 children. It affects the majority of male children and occurs 2-4 weeks after SARS-CoV-2 infection. Patients with MIS-C have elevated biomarkers associated with vascular inflammation and damage. 70-90% of children with MIS-C show symptoms like fever, abdominal pain, vomiting, and diarrhea. Hematologic abnormalities are also observed. 50% of children with MIS-C suffer from shock and approximately 50-80% have a critical illness that requires intensive care.

Cardiac involvement is seen in 67-80% of children with MIS-C. Ventricular dysfunction is a common finding of MIS-C affecting around 33–50% of patients. Coronary artery aneurysms are prevalent among 13-26% and are more common in male patients and in those with mucocutaneous and conjunctival involvement. The prevalence rate of arrhythmias and conduction abnormalities is 28–67% among the MIS-C patients.

Thrombotic complications are common with MIS-C and have a higher mortality rate. Furthermore, myocarditis can occur in acute COVID-19 infected adults and pediatric patients. When MIS-C is suspected, a thorough cardiac evaluation including troponin and brain natriuretic peptide (BNP) levels, ECG, transthoracic echocardiogram, MRI (CMR), and CT of the chest should be urgently obtained.

MIS-C management includes supportive care and immunomodulatory therapy. MIS-C patients are often hemodynamically unstable and require ICU hospitalization. In severe cases, extracorporeal membranous oxygenation (ECMO) may be required. MIS-C mortality rates are 1.7-2%. Initial treatment of MIS-C cardiac complications includes patient stabilization, mechanical ventilation, and inotropic support followed by treating inflammation, reducing coronary artery dilation, and minimizing risks for intra-cardiac or coronary artery thrombi. Immunomodulatory treatment with intravenous immunoglobulin (IVIG) and/or corticosteroids are considered as first-line agents. IL-1 receptor antagonists, tocilizumab and monoclonal, are the most commonly used biologic therapies. Current treatment strategies are effective in resolving cardiac manifestations but still need to be improved.

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Source: Current Cardiology Reports