Русский
Analysis of the dynamics of electrocardiograms of patients who died from COVID-19 on admission, during treatment in a hospital and before death
DOI: https://dx.doi.org/10.18565/therapy.2024.3.26-40
Saifutdinov R.G., Saifutdinov R.R., Saifutdinova T.V., Galyautdinova A.A., Muginova L.K., Galiullina G.F., Gilmullina R.R., Kutlubaeva A.R., Mardanshina V.F., Minnebaeva A.A., Murakaev T.R., Mukhametsyanova A.F., Nasyrova G.F., Trefilova Yu.S., Khamatshina M.R.
1) Kazan State Medical Academy – a branch of Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia; 2) City Clinical Hospital No. 12, Kazan; 3) City Clinical Hospital No. 18, Kazan
The aim: to study the ECGs of deceased COVID-19 patients upon admission, during hospital treatment and before death.
Material and methods. From 01.06.2020 to 01.06.2021, 2641 patient with COVID-19 was examined and treated in the temporary COVID hospital in Kazan. 122 of these patients (4.6%) died. 117 patients who died (4.4%) underwent ECG testing. All ECGs were analyzed by three independent specialists in electrocardiography. Heart rate, position of cardiac electrical axis, rhythm (sinus, atrial, atrioventricular, atrial fibrillation and flutter, ventricular), extrasystoles (supraventricular and ventricular), blocks (atrial, atrioventricular, bundle branches), acute myocardial infarction (AMI) and previous myocardial infarction, ST segment and T wave abnormalities and ischemic disorders were assessed.
Results. Patients with COVID-19 died more often with sinus tachycardia. Predominance of sinus bradycardia in such patients was not detected. Before death, both female and male patients had a decrease in the number of supraventricular (about 2 times) and ventricular extrasystoles (more than 3 times), as well as 1st degree atrioventricular blocks. Complete blockade of the left bundle branch was not found in any patient upon admission; incomplete blockade was found in only 1 male patient (it persisted even before death). The number of cases of incomplete block of the right bundle branch before death decreased in both females and males; the number of patients with complete block of the right bundle branch remained virtually unchanged. The cases of blockade of the anterior superior branch of the left bundle branch before death in females decreased, while in male patients this number remained the same as on admission. The number of patients with myocardial ischemia in the pre-death period among females increased by more than 2.5 times, among men this figure remained almost unchanged. Changes in the T wave were observed more often. AMI was not diagnosed in any patient upon admission, while before death it was recorded somewhat more often in female patients than in male ones.
Conclusion. COVID-19 occurs with ECG abnormalities. Therefore, it is important that doctors know them well and make adequate decisions.
Literature
1. Huang C., Wang Y., Li X. et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395(10223): 497–506. https://doi.org/10.1016/S0140-6736(20)30183-5. PMID: 31986264. PMCID: PMC7159299. 2. Long B., Brady W.J., Bridwell R.E. et al. Electrocardiographic manifestations of COVID-19. Am J Emerg Med. 2021; 41: 96–103. https://doi.org/10.1016/j.ajem.2020.12.060. PMID: 33412365. PMCID: PMC7771377. 3. Sultanian P., Lundgren P., Stromsoe A. et al. Cardiac arrest in COVID-19: Characteristics and outcomes of in- and out-of-hospital cardiac arrest. A report from the Swedish Registry for Cardiopulmonary Resuscitation Eur Heart J. 2021; 42(11): 1094–106. https://doi.org/10.1093/eurheartj/ehaa1067. PMID: 33543259. PMCID: PMC7928992. 4. Jaiswal V., Sarfraz Z., Sarfraz A. et al. COVID-19 infection and myocarditis: A state-of-the-art systematic review. J Prim Care Community Health. 2021; 12: 21501327211056800. https://doi.org/10.1177/21501327211056800. PMID: 34854348. PMCID: PMC8647231. 5. Giustino G., Croft L.B., Stefanini G.G. et al. Characterization of myocardial injury in patients with COVID-19. J Am Coll Cardiol. 2020; 76 (18): 2043–55. https://doi.org/10.1016/j.jacc.2020.08.069. PMID: 33121710. PMCID: PMC7588179. 6. Mitrani R.D., Dabas N., Goldberger J.J. COVID-19 cardiac injury: Implications for long-term surveillance and outcomes in survivors. Heart Rhythm. 2020; 17(11): 1984–90. https://doi.org/10.1016/j.hrthm.2020.06.026. PMID: 32599178. PMCID: PMC7319645. 7. Sciaccaluga C., Cameli M., Menci D. et al. COVID-19 and the burning issue of drug interaction: Never forget the ECG. Postgrad Med J. 2021; 97(1145): 180–84. https://doi.org/10.1136/postgradmedj-2020-138093. PMID: 32820084. PMCID: PMC10016843. 8. Dabbagh M.F., Aurora L., D’Souza P. et al. Cardiac tamponade secondary to COVID-19. JACC Case Rep. 2020; 2(9): 1326–30. https://doi.org/10.1016/j.jaccas.2020.04.009. PMID: 32328588 PMCID: PMC7177077. 9. Vidovich M.I. Transient Brugada-like ECG pattern in a patient with coronavirus disease 2019 (COVID-19). JACC Case Rep. 2020; 2(9): 1245–49. https://doi.org/10.1016/j.jaccas.2020.04.007. PMID: 32309815. PMCID: PMC7162623. 10. Временные методические рекомендации «Профилактика, диагностика и лечение новой коронавирусной инфекции (COVID-19)». Версия 6 (28.04.20). Минздрав России. Доступ: https://base.garant.ru/73964533/ (дата обращения – 11.01.2023). (Interim guidelines «Prevention, diagnosis and treatment of new coronavirus infection (COVID-19)». Version 6 (04/28/20). Ministry of Healthcare of Russia. URL: https://base.garant.ru/73964533/ (date of access – 11.01.2023) (In Russ.)). 11. Antwi-Amoabeng D., Beutler B.D., Singh S. et al. Association between electrocardiographic features and mortality in COVID-19 patients. Ann Noninvasive Electrocardiol. 2021; 26(4): e12833. https://doi.org/10.1111/anec.12833. PMID: 33742501. PMCID: PMC8250310. 12. Abrams M.P., Wan E.Y., Waase M.P. et al. Clinical and cardiac characteristics of COVID-19 mortalities in a diverse New York City Cohort. J Cardiovasc Electrophysiol. 2020; 31(12): 3086–96. https://doi.org/10.1111/jce.14772. PMID: 33022765. PMCID: PMC7675758. 13. Mountantonakis S.E., Saleh M., Fishbein J. et al. Atrial fibrillation is an independent predictor for in-hospital mortality in patients admitted with SARS-CoV-2 infection. Heart Rhythm. 2021; 18(4): 501–7. https://doi.org/10.1016/j.hrthm.2021.01.018. PMID: 33493650. PMCID: PMC7825902. 14. Орлов В.Н. Руководство по электрокардиографии. 9-е изд., испр. М.: Медицинское информационное агентство. 2017; 560 с. (Orlov V.N. Guide to electrocardiography. 9th ed., rev. Moscow: Medical News Agency. 2017; 560 pp. (In Russ.)). ISBN: 978-5-8948-1983-9. 15. Bangalore S., Sharma A., Slotwiner A. et al. ST-segment elevation in patients with Covid-19 – A case series. N Engl J Med. 2020; 382(25): 2478–80. https://doi.org/10.1056/NEJMc2009020. PMID: 32302081. PMCID: PMC7182015. 16. Lanza G.A., De Vita A., Ravenna S.E. et al. Electrocardiographic findings at presentation and clinical outcome in patients with SARS-CoV-2 infection. Europace. 2021; 23(1): 123–29. https://doi.org/10.1093/europace/euaa245. PMID: 33097933. PMCID: PMC7665485. 17. Сыркин А.Л. Инфаркт миокарда. 5-е изд., перераб. и доп. М: Медицинское информационное агентство. 2011; 466 с. (Syrkin A.L. Myocardial infarction. 5th ed., revised. and additional. Moscow: Medical News Agency. 2011; 466 pp. (In Russ.)). 18. Руководство по кардиологии. Под ред. Чазова Е.И. Т. 3. М.: Практика. 2014; 864 c. (Guide to Cardiology. Ed. By Chazov E.I. Vol. 3. Moscow: Praktika. 2014; 864 pp. (In Russ.)). ISBN: 978-5-89816-130-9. 19. Майстрах К.В., Родов Я.И., Лаврова И.Г. Пособие к практическим занятиям по организации здравоохранения. 3-е изд., перераб. М.: Медицина. 1967; 263 с. (Maystrakh K.V., Rodov Ya.I., Lavrova I.G. A manual for practical training in healthcare organization. 3rd ed., revised. Moscow: Meditsina. 1967; 263 pp. (In Russ.)). 20. Рокицкий П.Ф. Биологическая статистика. Минск: Вышэйш школа. 1973; 320 с. (Rokitsky P.F. Biological statistics. Minsk: Vysheysh shkola. 1973; 320 pp. (In Russ.)). 21. Сайфутдинов Р.Р., Сайфутдинов Р.Г., Ахметов Р.У., Сайфутдинова Т.В. Особенность госпитальной летальности при COVID-19. Дневник Казанской медицинской школы. 2022; (2): 15–25. (Saifutdinov R.G., Saifutdinov R.R., Akhmetov R.U., Saifutdinova T.V. The peculiarity of hospital mortality in COVID-19. Dnevnik Kazanskoy meditsinskoy shkoly = Diary of Kazan Medical School. 2022; (2): 15–25 (In Russ.)). EDN: JOWMPC. 22. Saifutdinov R.R., Saifutdinov R.G., Akhmetov R.U., Saifutdinova T.V. The peculiarity of hospital letalis in COVID-19. EC Clinical and Medical Case Reports. 2022; 5(12): 35–47. 23. Gopinathannair R., Merchant F.M., Lakkireddy D.R. et al. COVID-19 and cardiac arrhythmias: A global perspective on arrhythmia characteristics and management strategies. J Interv Card Electrophysiol. 2020; 59(2): 329–36. https://doi.org/10.1007/s10840-020-00789-9. PMID: 32494896. PMCID: PMC7268965. 24. De Carvalho H., Leonard-Pons L., Segard J. et al. Electrocardiographic abnormalities in COVID-19 patients visiting the emergency department: A multicenter retrospective study. BMC Emergency Medicine. BMC Emerg Med. 2021; 21(1): 141. https://doi.org/10.1186/s12873-021-00539-8. PMID: 34798827. PMCID: PMC8603337. 25. Romero J., Gabr M., Diaz J.C. et al. Electrocardiographic features of patients with COVID-19: An updated review. Card Electrophysiol Clin. 2022; 14(1): 63–70. https://doi.org/10.1016/j.ccep.2021.10.006. PMID: 35221086. PMCID: PMC8556537. 26. Beyls C., Martin N., Hermida A. et al. Lopinavir – ritonavir treatment for COVID-19 infection in intensive care unit. Risk of bradycardia. Circ Arrhythm Electrophysiol. 2020; 13(8): e008798. https://doi.org/10.1161/CIRCEP.120.008798. PMID: 32809882. PMCID: PMC7446985. 27. Brunetti N.D., Poliseno M., Bottalico I.F. et al. Safety and heart rate changes in Covid-19 patients treated with remdesivir. Int J Infect Dis. 2021; 112: 254–57. https://doi.org/10.1016/j.ijid.2021.09.036. PMID: 34551344. PMCID: PMC8451471. 28. Barman H.A., Atici A., Alici G. et al. The effect of the severity COVID-19 infection on electrocardiography. Am J Emerg Med. 2021; 46: 317–22. https://doi.org/10.1016/j.ajem.2020.10.005. PMID: 33059987. PMCID: PMC7539927. 29. Кушаковский М.С. Аритмии сердца. Руководство для врачей. СПб: Фолиант. 1998; 640 с. (Kushakovsky M.S. Cardiac arrhythmias. Guide for physicians. Saint Petersburg: Foliant. 1998; 640 pp. (In Russ.)). 30. Al-Khatib S.M., Stebbins A.L., Califf R. M. et al. Sustained ventricular arrhythmias and mortality among patients with acute myocardial infarction: Results from the GUSTO-III trial. Am Heart J. 2003; 145(3): 515–21. https://doi.org/10.1067/mhj.2003.170. PMID: 12660676. 31. Avezum A., Piegas L. S., Goldberg R. J. et al. Magnitude and prognosis associated with ventricular arrhythmias in patients hospitalized with acute coronary syndromes (from the GRACE Registry). Am J Cardiol. 2008; 102(12): 1577–82. https://doi.org/10.1016/j.amjcard.2008.08.009. PMID: 19064008. 32. Ozdemir I.H., Ozlek B., Ozen M.B. Fragmented QRS is a marker of mortality in patients with severe COVID-19: A retrospective observational study. Anatol J Cardiol. 2021; 25(11): 811–20. https://doi.org/10.5152/AnatolJCardiol.2021.62. PMID: 34734815. PMCID: PMC8575396. 33. Сайфутдинов Р.Г., Ахметов Р.У., Сайфутдинов Р.Р. с соавт. К вопросу о гипергликемии при COVID-19. Дневник Казанской медицинской школы. 2022; (3): 4–10. (Saifutdinov R.G., Akhmetov R.U., Saifutdinov R.R. et al. On the issue of hyperglycemia in COVID-19. Dnevnik Kazanskoy meditsinskoy shkoly = Diary of Kazan Medical School. 2022; (3): 4–10 (In Russ.)). EDN: GNLZYV. 34. Khunti K., Del Prato S., Mathieu C. et al. COVID-19, hyperglycemia, and new-onset diabetes. Diabetes Care. 2021; 44(12): 2645–55. https://doi.org/10.2337/dc21-1318. PMID: 34625431. PMCID: PMC8669536. 35. Michalakis K., Ilias I. COVID-19 and hyperglycemia/diabetes. World J Diabetes. 2021; 12(5): 642–50. https://doi.org/10.4239/wjd.v12.i5.642. PMID: 33995851. PMCID: PMC8107977. 36. Saifutdinov R.G., Saifutdinov R.R., Achmedov R.U. et al. Hyperglycemia in COVID-19. Review. EC Clinical and Medical Case Reports. 2023; 6(4): 9–18. 37. Roy S., Demmer R.T. Impaired glucose regulation, SARS-CoV-2 infections and adverse COVID-19 outcomes. Transl Res. 2022; 241: 52–69. https://doi.org/10.1016/j.trsl.2021.11.002. PMID: 34763125. PMCID: PMC8575538. 38. Килинский Е.Л., Высокий Ф.Ф. Генез электрокардиографических изменений при сахарной пробе. Вестник АМН. 1965; 20(10): 72–77. (Kilinsky E.L., Vysoky F.F. Genesis of electrocardiographic changes during a sugar test. Vestnik Akademii meditsinskikh nauk SSSR = Bulletin of the Academy of Medical Sciences. 1965; 20(10): 72–77 (In Russ.)). 39. Brest A.N., Wiener L., Chung E.K., Kasparian M., eds. Innovations in the diagnosis and management of acute myocardial infarction. Philadelphia: FA Davis. 1975; 157 pp. ISBN-10: 0803611900. ISBN-13: 978-0803611900. 40. Sarda A.K., Thute P. Importance of ECG in the diagnosis of acute pericarditis and myocardial infarction: A review article. Cureus. 2022; 14(10): e30633. https://doi.org/10.7759/cureus.30633. PMID: 36426313. PMCID: PMC9683083. 41. Poterucha T.J., Elias P., Jain S.S. et al. Admission cardiac diagnostic testing with electrocardiography and troponin measurement prognosticates increased 30-day mortality in COVID-19. J Am Heart Assoc. 2021; 10(1): e018476. https://doi.org/10.1161/JAHA.120.018476. PMID: 33169643. PMCID: PMC7955502. 42. Hu, B., Deng, Q., Zhou, Q. Cardiac involvement of COVID-19: Looking forward to novel discoveries and clinically valuable evidence. Int J Cardiol. 2020; 314: 95. https://doi.org/10.1016/j. ijcard.2020.05.049. PMID: 32560765. PMCID: PMC7295706. 43. Loghin C., Chauhan S., Lawless S.M. et al. Pseudo acute myocardial infarction in a young COVID-19 patient. JACC Case Rep. 2020; 2(9): 1284–88. https://doi.org/10.1016/j.jaccas.2020.04.015. PMID: 32342049. PMCID: PMC7183966. 44. Deng Q., Hu B., Zhang Y. et. al. Suspected myocardial injury in patients with COVID-19: Evidence from front-line clinical observation in Wuhan, China. Int J Cardiol. 2020; 311: 116–21. https://doi.org/10.1016/j.ijcard.2020.03.087. PMID: 32291207. PMCID: PMC7141178. 45. Dec G.W. Introduction to clinical myocarditis. In: Cooper L.T., ed. Myocarditis: From bench to bedside. Totowa, NJ: Humana Press. 2003; pp. 257–81. https://doi.org/10.1007/978-1-59259-319-4. ISBN: 978-1-59259-319-4. 46. Petersen M., Mehrad B., Keeley E.C. Acute myocarditis during the COVID-19 pandemic: A single center experience. Am Heart J Plus. 2021; 5: 100030. https://doi.org/10.1016/j.ahjo.2021.100030. PMID: 34189492. PMCID: PMC8223126. 47. Сайфутдинов Р.Г., Пак Э.В., Петровcкая Е.О., Нугайбекова Л.А. Стресс-индуцированная кардиомиопатия. Дневник Казанской медицинской школы. 2014; (2): 53–58. (Sayfutdinov R.G., Pak E.V., Petrovskaya E.O., Nugaybekova L.A. Stress-induced cardiomyopathy. Dnevnik Kazanskoy meditsinskoy shkoly = Diary of Kazan Medical School. 2014; (2): 53–58 (In Russ.)). EDN: SGNWOB. 48. Sala S., Peretto G., Gramegna M. et al. Acute myocarditis presenting as a reverse Tako-Tsubo syndrome in a patient with SARS-CoV-2 respiratory infection. Eur Heart J. 2020; 41 (19): 1861–62. https://doi.org/10.1093/eurheartj/ehaa286. PMID: 32267502. PMCID: PMC7184339. 49. Prasad A., Lerman A., Rihal C.S. Apical ballooning syndrome (TakoTsubo or stress cardiomyopathy): A mimic of acute myocardial infarction. Am Heart J. 2008; 155 (3): 408–17. https://doi.org/10.1016/j.ahj.2007.11.008. PMID: 18294473. 50. (Sato H., Tateishi H., Uchida T. et al. Tako-Tsubo – like left ventricular dysfunction due to multivessel coronary spasm. In: Kodama K., Haze K., Hori M., eds. Clinical aspect of myocardial injury: From ischemia to heart failure. Tokyo: Kagakuhyoronsha Publishing Co. 1990; pp. 56–64 (In Japanese)). 51. Гиляревский С.Р. Миокардиты: современные подходы к диагностике и лечению. М.: Медиа Сфера. 2008; 324 с. (Gilyarevsky S.R. Myocarditis: Modern approaches to diagnosis and treatment. Moscow: Media Sfera. 2008; 324 pp. (In Russ.)). ISBN: 5-89084-025-8. EDN: QLSJPP. 52. Гиляревский С.Р., Косолапов Д.А., Лопотовский П.Ю. с соавт. Стрессовая кардиомиопатия, или кардиомиопатия takotsubo (такотсубо). Сердечная недостаточность. 2010; 11(5): 306–314. (Gilyarevsky S.R., Kosolapov D.A., Lopotovsky P.Yu. et al. Stress cardiomyopathy, or takotsubo cardiomyopathy. Serdechnaya nedostatochnost’ = Heart Failure. 2010; 11(5): 306–314 (in Russ.)). EDN: MXGFOJ.
About the Autors
Rafik G. Saifutdinov, MD, Dr. Sci.(Medicine), professor, head of the Department of hospital and outpatient therapy, Kazan State Medical Academy – a branch of Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia. Address: 420012, Kazan, 36 Butlerova St.
E-mail: rgsbancorp@mail.ru
ORCID: https://orcid.org/0000-0003-2839-100X
Rinat R. Saifutdinov, MD, PhD (Medicine), associate professor of the Department of hospital and polyclinic therapy, Kazan State Medical Academy – a branch of Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia, head of the Department of therapy, City Clinical Hospital No. 12, Kazan. Address: 420012, Kazan, 36 Butlerova St.
E-mail: r_saifutdinov@mail.ru
Tatyana V. Saifutdinova, MD, assistant at the Department of therapy, geriatrics and family medicine, Kazan State Medical Academy – a branch of Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia. Address: 420012, Kazan, 36 Butlerova St.
E-mail: saifutdinova_t@mail.ru
Alsu A. Galyautdinova, MD., doctor of the Functional Department, City Clinical Hospital No. 12, Kazan. Address: 420036, Kazan, 7 Lechebnaya St.
Laysan K. Muginova, MD, doctor of the Functional Department, City Clinical Hospital No. 12, Kazan. Address: 420036, Kazan, 7 Lechebnaya St.
Gulnara F. Galiullina, MD, clinical resident of the Department of hospital and polyclinic therapy, Kazan State Medical Academy – a branch of Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia. Address: 420012, Kazan, 36 Butlerova St.
E-mail: english-worker@mail.ru
Rania R. Gilmullina, MD, clinical resident of the Department of hospital and polyclinic therapy, Kazan State Medical Academy – a branch of Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia. Address: 420012, Kazan, 36 Butlerova St.
E-mail: kalinino10@gmail.com
Anastasia R. Kutlubaeva, MD, clinical resident of the Department of hospital and polyclinic therapy, Kazan State Medical Academy – a branch of Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia. Address: 420012, Kazan, 36 Butlerova St.
E-mail: Nastyakutlubaeva@mail.ru
Veronika F. Mardanshina, MD, clinical resident of the Department of hospital and polyclinic therapy, Kazan State Medical Academy – a branch of Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia. Address: 420012, Kazan, 36 Butlerova St.
E-mail: 2010_semya@mail.ru
Adelya A. Minnebaeva, MD, clinical resident of the Department of hospital and polyclinic therapy, Kazan State Medical Academy – a branch of Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia. Address: 420012, Kazan, 36 Butlerova St.
Timur R. Murakaev, MD, clinical resident of the Department of hospital and polyclinic therapy, Kazan State Medical Academy – a branch of Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia. Address: 420012, Kazan, 36 Butlerova St.
E-mail: murakaevafarida@yandex.ru
Nailya A. Mukhametzyanova, MD, PhD (Medicine), head of the Functional Department, City Clinical Hospital No. 18, Kazan. Address: 420101, Kazan, 2 Kh. Mavlyutova St.
E-mail: Gb18ofdzav@mail.ru
Gulnara F. Nasyrova, MD, clinical resident of the Department of hospital and polyclinic therapy, Kazan State Medical Academy – a branch of Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia. Address: 420012, Kazan, 36 Butlerova St.
E-mail: khasanshina.gulnara@yandex.ru
Yulia S. Trefilova, MD, clinical resident of the Department of hospital and polyclinic therapy, Kazan State Medical Academy – a branch of Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia. Address: 420012, Kazan, 36 Butlerova St.
E-mail: uliyatrefilova@gmail.com
Milyausha R. Khamatshina, MD, clinical resident of the Department of hospital and polyclinic therapy, Kazan State Medical Academy – a branch of Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia. Address: 420012, Kazan, 36 Butlerova St.
E-mail: milyaushaa2500@mail.ru
Similar Articles
