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COVID-19-associated multisystem inflammatory syndrome in children presenting uniquely with sinus node dysfunction in the setting of shock

Part of: Echocardiography

Published online by Cambridge University Press:  22 March 2021

Lesya G. Tomlinson Open the ORCID record for Lesya G. Tomlinson [Opens in a new window] ,
Mitchell I. Cohen ,
Rebecca E. Levorson  and
Megan B. Tzeng
Lesya G. Tomlinson*
Affiliation:
Department of Pediatrics, INOVA Fairfax Children’s Hospital, 3300 Gallows Road, Falls Church, VA22042, USA
Mitchell I. Cohen
Affiliation:
Department of Electrophysiology and Cardiology, INOVA Fairfax Children’s Hospital, 3300 Gallows Road, Falls Church, VA22042, USA
Rebecca E. Levorson
Affiliation:
Department of Infectious Disease, Pediatric Specialists of Virginia, 3023 Hamaker Ct Suite 600, Fairfax, VA22031, USA
Megan B. Tzeng
Affiliation:
Department of Pediatric Critical Care Medicine, INOVA Fairfax Children’s Hospital, 3300 Gallows Road, Falls Church, VA22042, USA
*
Author for correspondence: Lesya G. Tomlinson, Department of Pediatrics, INOVA Fairfax Children’s Hospital, 3300 Gallows Road, Falls Church, VA22042, USA. Tel: 703-776-6652; Fax: 703-776-6432. E-mail: Lesya.Tomlinson@inova.org
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Abstract

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.

Keywords

COVID-19shockidioventricular rhythmmultisystem inflammatory syndrome in children
Type
Brief Report
Information
Cardiology in the Young , Volume 31 , Issue 7 , July 2021 , pp. 1202 - 1204
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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References

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