COVID-19 associated cardiac arrest differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sara Zand, M.D.

Overview

COVID-19 associated inheritted cardiac arrest must be differentiated from other causes of cardiac arrest.

Differentiating inherited cardiac arrest from other causes of cardiac arrest

Inherited causes of cardiac arrest and malignant arrhythmia associated COVID-19 long QT syndrome Brugada syndrome Short QT syndrome Cathecolaminergic polymorphic ventricular tachaycardia
Gene mutation
  • loss of function in SCN5A in %30 of patients
EKG finding
  • QTc>450ms in men
  • QTc>470ms in women
  • Coved-type ST-segment elevation
  • T-wave inversion

in lead V1 and/or V2

Specific considerations in COVID19 patients
  • Controlling the fever for prevention of QT prolongation
  • Avoidance of using≥ one drugs inducing QT prolongation
  • Controlling the fever as the main cause of cardiac arrest in brugada syndrome, especially in children less than 5 year old
  • Avoidance of administration of epinephrine, isoproterenol, and dobutamine, all α and/or B1 receptor agonists inducing ventricular arrhythmia
  • Controlling the stress related to COVID-19
  • Safety of flecainide without any interaction with lopinavir, ritonavir, and chloroquine.
fatal arrhythmia Ventricular fibrillation
  • QT, QTc is measured in milliseconds.
  • RR is measured in seconds and is the interval from the onset of one QRS complex to the onset of the next QRS complex.

References

  1. ↑ Antzelevitch C, Yan GX, Ackerman MJ, Borggrefe M, Corrado D, Guo J, Gussak I, Hasdemir C, Horie M, Huikuri H, Ma C, Morita H, Nam GB, Sacher F, Shimizu W, Viskin S, Wilde AA (October 2016). "J-Wave syndromes expert consensus conference report: Emerging concepts and gaps in knowledge". Heart Rhythm. 13 (10): e295–324. doi:10.1016/j.hrthm.2016.05.024. PMC 5035208. PMID 27423412.
  2. ↑ van der Werf C, Wilde AA (April 2013). "Catecholaminergic polymorphic ventricular tachycardia: from bench to bedside". Heart. 99 (7): 497–504. doi:10.1136/heartjnl-2012-302033. PMID 23390049.
  3. ↑ van Noord C, Eijgelsheim M, Stricker BH (July 2010). "Drug- and non-drug-associated QT interval prolongation". Br J Clin Pharmacol. 70 (1): 16–23. doi:10.1111/j.1365-2125.2010.03660.x. PMC 2909803. PMID 20642543.
  4. ↑ Priori, Silvia G.; Wilde, Arthur A.; Horie, Minoru; Cho, Yongkeun; Behr, Elijah R.; Berul, Charles; Blom, Nico; Brugada, Josep; Chiang, Chern-En; Huikuri, Heikki; Kannankeril, Prince; Krahn, Andrew; Leenhardt, Antoine; Moss, Arthur; Schwartz, Peter J.; Shimizu, Wataru; Tomaselli, Gordon; Tracy, Cynthia (2013). "HRS/EHRA/APHRS Expert Consensus Statement on the Diagnosis and Management of Patients with Inherited Primary Arrhythmia Syndromes". Heart Rhythm. 10 (12): 1932–1963. doi:10.1016/j.hrthm.2013.05.014. ISSN 1547-5271.
  5. ↑ White NJ (August 2007). "Cardiotoxicity of antimalarial drugs". Lancet Infect Dis. 7 (8): 549–58. doi:10.1016/S1473-3099(07)70187-1. PMID 17646028.
  6. ↑ Amin AS, Herfst LJ, Delisle BP, Klemens CA, Rook MB, Bezzina CR, Underkofler HA, Holzem KM, Ruijter JM, Tan HL, January CT, Wilde AA (July 2008). "Fever-induced QTc prolongation and ventricular arrhythmias in individuals with type 2 congenital long QT syndrome". J. Clin. Invest. 118 (7): 2552–61. doi:10.1172/JCI35337. PMC 2423868. PMID 18551196.
  7. ↑ Amin AS, Meregalli PG, Bardai A, Wilde AA, Tan HL (August 2008). "Fever increases the risk for cardiac arrest in the Brugada syndrome". Ann. Intern. Med. 149 (3): 216–8. doi:10.7326/0003-4819-149-3-200808050-00020. PMID 18678856.
  8. ↑ Michowitz Y, Milman A, Sarquella-Brugada G, Andorin A, Champagne J, Postema PG, Casado-Arroyo R, Leshem E, Juang J, Giustetto C, Tfelt-Hansen J, Wijeyeratne YD, Veltmann C, Corrado D, Kim SH, Delise P, Maeda S, Gourraud JB, Sacher F, Mabo P, Takahashi Y, Kamakura T, Aiba T, Conte G, Hochstadt A, Mizusawa Y, Rahkovich M, Arbelo E, Huang Z, Denjoy I, Napolitano C, Brugada R, Calo L, Priori SG, Takagi M, Behr ER, Gaita F, Yan GX, Brugada J, Leenhardt A, Wilde A, Brugada P, Kusano KF, Hirao K, Nam GB, Probst V, Belhassen B (September 2018). "Fever-related arrhythmic events in the multicenter Survey on Arrhythmic Events in Brugada Syndrome". Heart Rhythm. 15 (9): 1394–1401. doi:10.1016/j.hrthm.2018.04.007. PMID 29649615. Vancouver style error: initials (help)
  9. ↑ Luo C, Wang K, Liu T, Zhang H (July 2018). "Computational Analysis of the Action of Chloroquine on Short QT Syndrome Variant 1 and Variant 3 in Human Ventricles". Conf Proc IEEE Eng Med Biol Soc. 2018: 5462–5465. doi:10.1109/EMBC.2018.8513572. PMID 30441573.
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