SARS-CoV-2 and Cardiovascular Complications in Children, Young Adults

Authors:
Jone PN, John A, Oster ME, et al., on behalf of the American Heart Association Leadership Committee and Congenital Cardiac Defects Committee of the Council on Lifelong Congenital Heart Disease and Heart Health in the Young; Council on Hypertension, and Council on Peripheral Vascular Disease.
Citation:
SARS-CoV-2 Infection and Associated Cardiovascular Manifestations and Complications in Children and Young Adults: A Scientific Statement From the American Heart Association. Circulation 2022;Apr 11:[Epub ahead of print].

This scientific statement from the American Heart Association Congenital Cardiac Defects Committee summarizes the current knowledge of health consequences of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children and young adults, with a focus on cardiovascular complications. Here are 10 key points to remember:

  1. Children <18 years of age have accounted for approximately 18% of total cases of SARS-CoV-2 infection, and 0.1% of deaths that have occurred in individuals <18 years of age. Young adults (18-29 years) have made up 21% of cases and 0.8% of deaths as of February 2022.
  2. Most children and young adults have mild disease, with close to 20% being asymptomatic. Unlike adults, loss of taste or smell occurs in <1% of children.
  3. Less than 2% of children with SARS-CoV-2 infection experience severe illness, among whom 75% have ≥1 comorbid condition, with obesity and asthma being the most common. Death occurred in 17% of the severely ill children.
  4. Children with congenital heart disease and pediatric solid organ transplant recipients have low infection and mortality rates from SARS-CoV-2 infection. Underlying genetic syndromes such as trisomy 21, or features such as diabetes, cyanosis, pulmonary hypertension, Eisenmenger, and heart failure are risk factors for severe illness, however.
  5. Multisystem inflammatory syndrome in children (MIS-C) is a rare complication of SARS-CoV-2 infection that can cause cardiomyopathy, arrhythmias, and coronary artery dilation. The estimated incidence rate of MIS-C is 1 per 3,000 cases of SARS-CoV-2 infection, with a disproportionate impact in Hispanic (1 per 2,000) and Black (1 per 1,500) children.
  6. The median age at diagnosis of MIS-C is 8 years, with the most common symptoms being fever (99%), gastrointestinal (87% vomiting/diarrhea), and rash (59%). Myocardial involvement is common and includes cardiomyopathy (28-55%), coronary aneurysms (12-21%), myocarditis (18%), and pericardial effusion (23%).
  7. MIS-C is attributed to a hyperimmune response to the virus in a genetically susceptible child, but the exact mechanisms are unknown.
  8. Inflammation and cardiovascular abnormalities resolve within 1-4 weeks of diagnosis. Mortality from MIS-C is rare and is estimated to occur in 1.4-1.9% of cases.
  9. Treatment of MIS-C relies on supportive care and immunomodulation with intravenous immunoglobulin in combination with corticosteroids, infliximab, and anakinra.
  10. Myocarditis attributed to the COVID-19 vaccine is rare and occurs 2-6 days post-vaccination, predominantly in males (93%), with a median age of 16 years. Benefits of the vaccine far outweigh the risks of myocarditis.

Clinical Topics: Arrhythmias and Clinical EP, Congenital Heart Disease and Pediatric Cardiology, Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Pericardial Disease, Prevention, Pulmonary Hypertension and Venous Thromboembolism, Stable Ischemic Heart Disease, Vascular Medicine, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Congenital Heart Disease, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Acute Heart Failure, Pulmonary Hypertension, Hypertension, Chronic Angina

Keywords: Adolescent, Arrhythmias, Cardiac, Asthma, Cardiomyopathies, Coronary Aneurysm, COVID-19, COVID-19 Vaccines, Diabetes Mellitus, Dilatation, Heart Defects, Congenital, Heart Failure, Hypertension, Pulmonary, Immunoglobulins, Intravenous, Inflammation, Myocarditis, Obesity, Organ Transplantation, Pediatrics, Pericardial Effusion, Primary Prevention, Risk Factors, SARS-CoV-2, Vaccination, Young Adult


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