Department of Pediatrics, INOVA Fairfax Children's Hospital, 3300 Gallows Road, Falls Church, VA22042, USA.
Department of Electrophysiology and Cardiology, INOVA Fairfax Children's Hospital, 3300 Gallows Road, Falls Church, VA22042, USA.
Cardiol Young. 2021 Jul;31(7):1202-1204. doi: 10.1017/S1047951121000354. Epub 2021 Mar 22.
SARS-CoV-2, which causes the disease COVID-19, generally has a mild disease course in children. However, a severe post-infectious inflammatory process known as multisystem inflammatory syndrome in children has been observed in association with COVID-19. This inflammatory process is a result of an abnormal immune response with similar clinical features to Kawasaki disease. It is well established that multisystem inflammatory syndrome in children is associated with myocardial dysfunction, coronary artery dilation or aneurysms, and occasionally arrhythmias. The most common electrocardiographic abnormalities seen include premature atrial or ventricular ectopy, variable degrees of atrioventricular block, and QTc prolongation, and rarely, haemodynamically significant arrhythmias necessitating extracorporeal membrane oxygenation support. However, presentation with fever, hypotension, and relative bradycardia with a left axis idioventricular rhythm has not been previously reported. We present a case of a young adolescent with multisystem inflammatory syndrome in children with myocarditis and a profoundly inappropriate sinus node response to shock with complete resolution following intravenous immunoglobulin.
导致 COVID-19 疾病的 SARS-CoV-2 在儿童中通常具有轻度疾病过程。然而，与 COVID-19 相关，已观察到一种称为儿童多系统炎症综合征的严重感染后炎症过程。这种炎症过程是异常免疫反应的结果，其临床特征与川崎病相似。众所周知，儿童多系统炎症综合征与心肌功能障碍、冠状动脉扩张或动脉瘤以及偶尔的心律失常有关。最常见的心电图异常包括房性或室性早搏、不同程度的房室传导阻滞和 QTc 延长，极少数情况下会出现需要体外膜氧合支持的血流动力学显著心律失常。然而，以前从未报道过以发热、低血压和相对心动过缓伴左轴室性节律为表现的病例。我们报告了一例患有心肌炎的儿童多系统炎症综合征病例，其窦性结对电击的反应非常不适当，静脉注射免疫球蛋白后完全缓解。
