Electrocardiograms of patients who survived after COVID-19
Abstract. Infection caused by SARS-CoV-2, seriously affects the cardiovascular system, which is manifested by changes in electrocardiogram (ECG).Saifutdinov R.G., Saifutdinov R.R., Galyautdinova A.A., Muginova L.K., Mukhametzyanova N.A., Akramzhanov A.T., Akhmetzyanova Z.I., Galiullina G.F., Gilmullina R.R., Dzyuina V.A., Murakaev T.R., Mukhametzyanova A.F., Sultanova E.R.
The aim: to study the ECG of patients survived from COVID-19.
Material and methods. 352 patients with COVID-19 underwent ECG upon admission, during treatment in hospital and before discharge. Heart rate (HR), cardiac electrical axis position, cardiac rhythm, extrasystoles, bundle branch block, ST segment and T wave (ST) abnormalities, ischemic events, and presence of acute myocardial infarction were estimated.
Results. Patients with COVID-19 were mostly admitted to the hospital with a normal heart rate. Sinus tachycardia was more often detected in females upon discharge and in male patients upon admission; sinus bradycardia was more often detected upon discharge than upon admission. This tendency was typical for both female and male individuals. Supraventricular and ventricular extrasystoles were rare. Atrial fibrillation and atrial flutter were twice as common in male, and first-degree atrioventricular blocks were found in female patients. No patients had incomplete left bundle branch block (LBBBi). Complete left bundle branch block (LBBBc) upon admission and discharge was registered in 3 male individuals. LBBBc, LBBBi and left anterior superior fascicle block were observed equally often both at admission and at discharge. Ischemic myocardial abnormalities were rare. cST and T anomalies were equally often verified both at admission and at discharge, they were almost 3 times more in females. Acute myocardial infarction was not diagnosed in any patient either at admission or at discharge.
Conclusion. Changes in ECG pattern of patients survived from COVID-19 are slightly different from those in individuals without this pathology.
Keywords
SARS-CoV-2
COVID-19
surviving patients
electrocardiography
References
1. Sciaccaluga C, Cameli M, Menci D, Mandoli GE, Sisti N, Cameli P et al. COVID-19 and the burning issue of drug interaction: Never forget the ECG. Postgrad Med J. 2021;97(1145):180–84.
PMID: 32820084. PMCID: PMC10016843. https://doi.org/10.1136/postgradmedj-2020-138093
2. Yu L, Liu Y, Feng Y. Cardiac arrhythmia in COVID-19 patients. Ann Noninvasive Electrocardiol. 2024;29(2):e13105.
PMID: 38339786. PMCID: PMC10858328. https://doi.org/10.1111/anec.13105
3. Thakur A, Kapil A, Deepti S. An abnormal ECG finding in a patient with COVID-19. JAMA Intern Med. 2023;183(11):1261–62.
PMID: 37695593. https://doi.org/10.1001/jamainternmed.2023.2457
4. Gomes JC, de Santana MA, Masood AI, de Lima CL, Dos Santos WP. СOVID‑19’s influence on cardiac function: A machine learning perspective on ECG analysis. Med Biol Eng Comput. 2023;61(5):1057–81.
PMID: 36662377. PMCID: PMC9854415. https://doi.org/10.1007/s11517-023-02773-7
5. Hashimoto H, Hiyoshi Y, Kabuki T, Sasaki H, Toda M. Prognostic value of ECG monitor findings in COVID-19. Open Heart. 2023;10(2):e002404.
PMID: 37963684. PMCID: PMC10649884. https://doi.org/10.1136/openhrt-2023-002404
6. Временные методические рекомендации Минздрава России «Профилактика, диагностика и лечение новой коронавирусной инфекции (COVID-19)». Версия 6 (28.04.2020). Доступ: https://minzdrav.gov.ru/system/attachments/attaches/000/050/122/original/28042020_%D0%9CR_COVID-19_v6.pdf (дата обращения – 21.03.2025). (Interim methodological recommendations of the Ministry of Healthcare of Russia “Prevention, diagnosis and treatment of new coronavirus infection (COVID-19)”. Version 6 (28.04.2020). URL: https://minzdrav.gov.ru/system/attachments/attaches/000/050/122/original/28042020_%D0%9CR_COVID-19_v6.pdf (date of access – 21.03.2025) (In Russ.)).
7. Сайфутдинов Р.Г., Сайфутдинов Р.Р., Сайфутдинова Т.В., Галяутдинова А.А., Мугинова Л.К., Галиуллина Г.Ф. с соавт. Анализ в динамике электрокардиограмм пациентов, умерших от COVID-19, при поступлении, в процессе лечения в стационаре и перед смертью. Терапия. 2024;10(3):26–40. (Saifutdinov RG, Saifutdinov RR, Saifutdinova TV, Galyautdinova AA, Muginova LK, Galiullina GF et al. Analysis of the dynamics of electrocardiograms of patients who died from COVID-19 on admission, during treatment in a hospital and before death. Terapiya = Therapy. 2024;10(3):26–40 (In Russ.)).
EDN: TMPIHI. https://doi.org/10.18565/therapy.2024.3.26-40
8. Chevrot G, Hauguel-Moreau M, Pépin M, Vieillard-Baron A, Lot A-S, Ouadahi M et al. Electrocardiogram abnormalities and prognosis in COVID-19. Front Cardiovasc Med. 2022;9:993479.
PMID: 36277756. PMCID: PMC9581294. https://doi.org/10.3389/fcvm.2022.993479
9. Souris M, Gonzalez J-P. COVID-19: Spatial analysis of hospital case fatality rate in France. PLoS ONE. 2020;15(12):e0243606.
PMID: 33320895. PMCID: PMC7737987. https://doi.org/10.1371/journal.pone.0243606
10. Antwi-Amoabeng D, Beutler BD, Singh S, Taha M, Ghuman J, Hanfy A et al. Association between electrocardiographic features and mortality in COVID-19 patients. Ann Noninvasive Electrocardiol. 2021;26(4):e12833.
PMID: 33742501. PMCID: PMC8250310. https://doi.org/10.1111/anec.12833
11. Jabbari L, Hayati S, Azizkhani L, Tavakol J. Association of electrocardiographic abnormalities and COVID-19 clinical outcomes. J Electrocardiol. 2023;78:76–79.
PMID: 36863119. PMCID: PMC9951026. https://doi.org/10.1016/j.jelectrocard.2023.02.002
12. Lanza GA, De Vita A, Ravenna SE, D’Aiello A, Covino M, Franceschi F, Crea F. Electrocardiographic findings at presentation and clinical outcome in patients with SARS-CoV-2 infection. Europace. 2021;23(1):123–29.
PMID: 33097933. PMCID: PMC7665485. https://doi.org/10.1093/europace/euaa245
13. De Carvalho H, Leonard-Pons L, Segard J, Goffinet N, Javaudin F, Martinage A 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.
PMID: 34798827. PMCID: PMC8603337. https://doi.org/10.1186/s12873-021-00539-8
14. Gur A, Ulutas Z. Characteristic electrocardiography findings of COVID-19 patients. Arch Iran Med. 2021;24(9):706–12.
PMID: 34816689. https://doi.org/10.34172/aim.2021.103
15. Tereshchenko LG, Pourbemany J, Haq KT, Patel H, Hyde J, Quadri S et al. An electrophysiological substrate of COVID-19. J Electrocardiol. 2023;79:61–65.
PMID: 36963283. PMCID: PMC10027233. https://doi.org/10.1016/j.jelectrocard.2023.03.010
16. Орлов В.Н. Руководство по электрокардиографии. 5-е изд., испр. М.: Медицинское информационное агентство. 2006; 528 с. (Orlov VN. Manual of electrocardiography. 5th edition, revised. Moscow: Medical Information Agency. 2006; 528 pp. (In Russ.)).
17. Romero J, Gabr M, Diaz JC, Purkayastha S, Gamero MT, Reynbakh O. et al. Electrocardiographic features of patients with COVID-19: An updated review. Card Electrophysiol Clin. 2022;14(1):63–70.
PMID: 35221086. PMCID: PMC8556537. https://doi.org/10.1016/j.ccep.2021.10.006
18. Abrams MP, Wan EY, Waase MP, Morrow JP, Dizon JM, Yarmohammadi H 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.
PMID: 33022765. PMCID: PMC7675758. https://doi.org/10.1111/jce.14772
19. Beyls C, Martin N, Hermida A , Abou-Arab O, Mahjoub Y. Lopinavir – ritonavir treatment for COVID-19 infection in intensive care unit. Risk of bradycardia. Circ Arrhythm Electrophysiol. 2020;13(8):e008798.
PMID: 32809882. PMCID: PMC7446985. https://doi.org/10.1161/circep.120.008798
20. Brunetti ND, Poliseno M, Bottalico IF, Centola A, Montemurro L, Sica S et al. Safety and heart rate changes in Covid-19 patients treated with remdesivir. Int J Infect Dis. 2021;112:254–57.
PMID: 34551344. PMCID: PMC8451471. https://doi.org/10.1016/j.ijid.2021.09.036
21. Barman HA, Atici A, Alici G, Sit O, Tugrul S, Gungor B et al. The effect of the severity COVID-19 infection on electrocardiography. Am J Emerg Med. 2021;46:317–22.
PMID: 33059987. PMCID: PMC7539927. https://doi.org/10.1016/j.ajem.2020.10.005
22. Ozdemir IH, Ozlek B, Ozen MB. 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.
PMID: 34734815. PMCID: PMC8575396. https://doi.org/10.5152/AnatolJCardiol.2021.62
23. Сайфутдинов Р.Г., Ахметов Р.У., Сайфутдинов Р.Р., Трефилова Ю.С., Сайфутдинова Т.В. К вопросу о гипергликемии при COVID-19. Дневник Казанской медицинской школы. 2022;(3):4–10. (Saifutdinov RG, Akhmetov RU, Saifutdinov RR, Trefilova YuS, Saifutdinova TV. On the issue of hyperglycemia in COVID-19. Dnevnik Kazanskoj meditsinskoj shkoly = Kazan medical school diary. 2022;(3):4–10 (In Russ.)). EDN: GNLZYV.
24. Khunti K, Del Prato S, Mathieu C, Kahn SE, Gabbay RA, Buse JB et al. COVID-19, hyperglycemia, and new-onset diabetes. Diabetes Care. 2021;44(12):2645–55.
PMID: 34625431. PMCID: PMC8669536. https://doi.org/10.2337/dc21-1318
25. Michalakis K, Ilias I. COVID-19 and hyperglycemia/diabetes. World J Diabetes. 2021;12(5):642–50.
PMID: 33995851. PMCID: PMC8107977. https://doi.org/10.4239/wjd.v12.i5.642
26. Saifutdinov RG, Saifutdinov RR, Achmedov RU, Trefilova US, Saifutdinova TV. Hyperglycemia in COVID-19. Review. EC Clinical and Medical Case Reports. 2023;6(4):9–18.
27. Roy S, Demmer RT. Impaired glucose regulation, SARS-CoV-2 infections and adverse COVID-19 outcomes. Transl Res. 2022;241:52–69.
PMID: 34763125. PMCID: PMC8575538. https://doi.org/10.1016/j.trsl.2021.11.002
28. Килинский Е.Л., Высокий Ф.Ф. Генез электрокардиографических изменений при сахарной пробе. Вестник Академии медицинских наук. 1965;20(10):72–77. (Kilinsky EL, Vysoky FF. The genesis of electrocardiographic changes in a sugar sample. Vestnik Akademii meditsinskikh nauk = Bulletin of the Academy of Medical Sciences. 1965;20(10):72–77 (In Russ.)).
29. Giustino G, Croft LB, Stefanini GG, Bragato R, Silbiger JJ, Vicenzi M et al. Characterization of myocardial injury in patients with COVID-19. J Am Coll Cardiol. 2020;76(18):2043–55.
PMID: 33121710. PMCID: PMC7588179. https://doi.org/10.1016/j.jacc.2020.08.069
About the Authors
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. Scopus ID: 36928957500. eLibrary SPIN: 2339-9660
Rinat R. Saifutdinov, MD, PhD (Medicine), associate professor, associate professor 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, head of the Department of therapy, City Clinical Hospital No. 12 of Kazan. Address: 420012, Kazan, 36 Butlerova St.
E-mail: r_saifutdinov@mail.ru
eLibrary SPIN: 5725-0092
Alsu A. Galyautdinova, MD, doctor of the Functional Department, City clinical hospital No. 12 of Kazan. Address: 420036, Kazan, 7 Lechebnaya St.
E-mail: gaa270565@yandex.ru
Laysan K. Muginova, MD, doctor of the Functional Department, City clinical hospital No. 12 of Kazan. Address: 420036, Kazan, 7 Lechebnaya St.
E-mail: Muginovalkk@gmail.com
Nailya A. Mukhametzyanova, MD, PhD (Medicine), head of the Functional Department, City Clinical Hospital No. 18 of Kazan. Address: 420101, Kazan, 2 Kh. Mavlyutova St.
E-mail: Gb18ofdzav@mail.ru
Akmal T. Akramzhanov, clinical resident 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: akromjanov3@gmail.com
Zilya I. Akhmetzyanova, clinical resident 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: zilunchik9@gmail.com
Gulnara F. Galiullina, clinical resident 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: english-worker@mail.ru
Rania R. Gilmullina, clinical resident 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: kalinino10@gmail.com
Varvara A. Dzyuina, clinical resident 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: pestereva.varvara@mail.ru
Timur R. Murakaev, clinical resident 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: murakaevafarida@yandex.ru
Aigul F. Mukhametzyanova, clinical resident 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: lolkeks98@mail.ru
Elina R. Sultanova, clinical resident 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: Elli-su.sultanova@yandex.ru
Similar Articles
