Damaging effects of Covid -19 Syndrome on Pediatric Heart

Dr Amitoz Singh Baidwan
Pediatric Cardiologist,
Aster Medcity, Kochi

The rapidly spreading COVID-19 pandemic has led to 28.8 million cases worldwide, leading to 9.21 lakh deaths. 7.2% of the total COVID-19 cases reported are pediatric.

Initially it was thought that children are resilient to COVID -19 infection, but that is not true anymore. Although most of the children during the initial phase of infection tend to remain asymptomatic or are mildly symptomatic, the most common presentation in children is seen after 3- 4 weeks of the exposure to COVID – 19 virus when they present as Pediatric Multisystem Inflammatory syndrome temporally associated with COVID -19 PIMS-TS, also labeled as Multisystem Inflammatory syndrome in children MIS-C by WHO (World Health Organisation) and CDC (Centers for Disease Control and Prevention).

Most of the children during the active stage of COVID -19 infection are asymptomatic but after 3-4 weeks of the exposure to the virus present a form of MIS-C which is an exaggerated form of inflation [WU1] in the body. It typically exhibits symptoms like persistence of  fever, headache, lethargy, vomiting, diarrhea,  rash  and  conjunctivitis.

Because of an abnormal inflammatory response, it has damaging effect on the heart, lungs and kidney which leads to hypotension, tachycardia and shock. In a recent publication in Journal E clinical medicine 662 children with MIS-C were evaluated, 71% required ICU admission, 60% were in shock, 52% required inotropic support, 39 % required respiratory support and mortality among them was 1.7 %.

Among these patients 54% had an abnormal echo-cardiogram which is significantly high. The cause of abnormal echo-cardiogram is mainly due to the involvement of cardiac muscle. Histopathological samples of cardiac muscle shows damage to cardiac myocytes, which is caused by the presence of the inflammatory cells in the cardiac muscles and to some extent by the virus itself.

Damage to the cardiac muscles leads to reduced pumping by the heart leading to fall in blood pressure as well as accumulation of fluid in the lungs. In addition to this, it has an effect on the coronary arteries leading to their dilatation and aneurysm formation which predisposes to develop clot formation in the coronary arteries.

Long term effect of the involvement of the coronary arteries will be known in the coming years. There is also inflammation of the covering layer of the heart i.e Pericardium leading to pericarditis and pericardial effusion.

IV immunoglobulins , corticosteroids , vasoactive support and anti-coagulants are the main medications required in the management of MIS – C. Overall the management is similar to Kawasaki disease as pathogenesis of the disease is quite similar.

It has a great similarity to Kawasaki disease and Toxic shock syndrome which can confuse the clinicians. This is a new childhood disease caused by COVID -19 virus , involvement of multiple organs such as lungs, heart, gastrointestinal tract and kidney leads to increased mortality among the pediatric population.