Cardiac Abnormalities Seen in Pediatric Patients During the SARS‐CoV2 Pandemic: An International Experience

Clark, Bradley C.; Sanchez‐de‐Toledo, Joan; Bautista‐Rodriguez, Carles; Choueiter, Nadine; Lara, Diego; Kang, Hechaan; Mohsin, Shazia; Fraisse, Alain; Cesar, Sergi; Sattar Shaikh, Abdul; Escobar‐Diaz, Maria C.; Hsu, Daphne T.; Randanne, Paula C.; Aslam, Nadeem; Kleinmahon, Jake; Lamour, Jacqueline M; Johnson, Jonathan N.; Sarquella‐Brugada, Georgia; Chowdhury, Devyani

BACKGROUND: During the SARS‐CoV2 pandemic, there has been increase in hyperinflammatory presentation in previously healthy children with a variety of cardiac manifestations. Our objective is to describe the cardiac manifestations found in an international cohort of 55 pediatric cases with multi‐system inflammatory syndrome (MIS‐C) during the SARS‐CoV2 pandemic. METHODS AND RESULTS: We reviewed data on previously healthy pediatric patients (≤18 years) with structurally normal hearts who presented at hospitals in the United States, United Kingdom, Spain and Pakistan with MIS‐C and had consultation with a pediatric cardiologist. Data collected included demographics, clinical presentation, laboratory values, electrocardiographic abnormalities, echocardiographic findings and initial therapies. A total of 55 patients presented with MIS‐C. Thirty‐five patients (64%) had evidence of decreased left ventricular function, 17 (31%) had valvulitis, 12 (22%) with pericardial effusion and 11 (20%) with coronary abnormalities. Twenty‐seven (49%) required ICU admission and 24 (44%) had evidence of shock. Eleven patients (20%) fulfilled complete Kawasaki disease criteria and had lower NT pro‐BNP, D‐dimer and ferritin levels compared with those who did not fulfill criteria. Electrophysiologic abnormalities occurred in 6 patients and included complete atrioventricular (AV) block, transient AV block and ventricular tachycardia. CONCLUSIONS: We describe the first international cohort of pediatric patients with MIS‐C during the SARS‐CoV2 pandemic with a range of cardiac manifestations. This paper brings awareness and alertness to the global medical community to recognize these children during the pandemic and understand the need for early cardiology evaluation and follow‐up.