Toddler endured temporary heart failure with coronavirus
A toddler endured heart complications after testing positive for the coronavirus.
Early research suggests the infection is mild in four out of five cases, however, it can trigger a disease called COVID-19.
Among adult patients who are ill enough to be hospitalised, previous studies imply 20% to 28% endure some form of cardiovascular complication, most of whom have pre-existing heart disease.
Medics have since reported how an unnamed two-year-old arrived at The Children’s Hospital at Montefiore in New York after choking and turning blue while eating.
An initial coronavirus test came back negative, however, a repeat swab turned out to be positive.
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Tests revealed the toddler had “myocardial injury due to the viral infection and heart failure symptoms exacerbated by the viral infection”.
The child made a full recovery and was discharged without a prescription for heart failure drugs.
“The presentation and clinical course of this patient mirrors four case reports of acute myocardial injury reported in adult patients with COVID-19,” said lead author Dr Madhu Sharma.
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“Most children with COVID-19 are either asymptomatic or have mild symptoms, but our case shows the potential for reversible myocardial injury in infants with COVID-19.
“Testing for COVID-19 in children presenting with signs and symptoms of heart failure is very important as we learn more about the impact of this virus.”
Watch: Can you catch coronavirus twice?
The toddler was born prematurely at 33 weeks, spending the first three weeks of their life in neonatal intensive care. The child is not thought to have any underlying health conditions, however.
The patient was taken to hospital after developing symptoms while eating, as described in The Journal of the American College of Cardiology.
They had not previously endured a fever or cough – tell-tale symptoms of the coronavirus, or any lesser signs of the infection, like diarrhoea.
After the second coronavirus test came back positive, an electrocardiogram – which records the electrical signals of the heart – suggested “myocardial injury due to the viral infection and heart failure symptoms exacerbated by the viral infection”.
Myocardial injury is generally defined as the proteins that regulate a heart’s beat being elevated in the blood, indicating some form of injury to the organ.
Heart failure occurs when the organ does not pump blood as efficiently as it should, with symptoms including breathlessness, fatigue and swollen lower limbs.
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The patient was treated via fluid resuscitation, the medical practice of replenishing fluid lost through processes like sweating.
Inotropic support, medication that changes the heart’s contraction, was given to raise the child’s low blood pressure.
Mechanical ventilation was also required after the toddler developed respiratory failure, when the lungs cannot deliver enough oxygen to the blood.
The patient also received the anti-malarial drug remdesivir under a compassionate use order, with it not being approved to treat the coronavirus.
Some studies have suggested the medication may accelerate a critically-ill coronavirus patient’s recovery, however, the results have been mixed.
How could coronavirus affect the heart?
The vast majority of people who become seriously ill with the coronavirus are elderly or have pre-existing health issues.
Viral infections are recognised as one of the most common causes of inflammation of the heart muscle, which reduces its ability to pump blood efficiently around the body.
Although unclear, the coronavirus may also replicate and spread through the blood and lymphatic system, entering the heart.
“Many viruses can affect the heart muscle as well as the lining around the outside of the heart that lubricates the heart's movement,” Professor Robert Storey from the University of Sheffield previously said.
“However, there is accumulating evidence [the coronavirus] is associated with a higher risk of heart muscle damage than most common viruses.
“This may partly relate to entry of the virus into the heart muscle cells and partly to the overwhelming inflammation that some patients experience, which can injure the heart muscle.”
Early in the outbreak, scientists from the University of Brescia in Italy analysed a healthy 35-year-old woman who showed signs of heart failure a week after the onset of coronavirus symptoms.
Although she stabilised following treatment, tests revealed parts of the walls of her heart were abnormally thick, resulting in contractility being reduced by up to 35%.
The circulating coronavirus is one of seven strains of a class of viruses that are known to infect humans.
Of all the strains, the circulating virus is said to be most genetically similar to severe acute respiratory syndrome (Sars), which killed 774 people during its 2002/3 outbreak.
Heart attacks were reported after patients overcame Sars, however, “most of the data” was “anecdotal”.
One study of 75 Sars patients found two in five died as a result of a heart attack, however, these findings were not replicated elsewhere.
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