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Cardiology

An Abnormal ECG Finding in a Patient With COVID-19

To identify the key insights or developments described in this article

1 Credit CME

JAMA Internal Medicine

Published Online: September 11, 2023

Challenges in Clinical Electrocardiography

Article Information and Disclosures

Abhishek Thakur, MD¹;

Anish Kapil, MD¹;

Siddharthan Deepti, MD, DM¹

Author Affiliations

¹Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India

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A patient in their 50s was admitted to the intensive care unit with severe COVID-19 pneumonia. Their medical history was notable for hypertension and diabetes for 10 years. At presentation, the patient’s oxygen saturation was 87% on room air and improved to 94% with oxygen supplementation. They were treated with steroids and parenteral anticoagulation. However, there was progressive deterioration that required mechanical ventilation and inotropic support by the seventh day of hospitalization. A 12-lead electrocardiogram (ECG) was performed because a ST-segment abnormality was observed on telemetry (Figure).

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A patient in their 50s was admitted to the intensive care unit with severe COVID-19 pneumonia. Their medical history was notable for hypertension and diabetes for 10 years. At presentation, the patient’s oxygen saturation was 87% on room air and improved to 94% with oxygen supplementation. They were treated with steroids and parenteral anticoagulation. However, there was progressive deterioration that required mechanical ventilation and inotropic support by the seventh day of hospitalization. A 12-lead electrocardiogram (ECG) was performed because a ST-segment abnormality was observed on telemetry (Figure).

Questions: What is the abnormality in the ECG? What is the immediate concern regarding management?

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Article Information

Corresponding Author: Siddharthan Deepti, MD, DM, Department of Cardiology, 7th Floor, CN Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India (deeptikailath@gmail.com).

Published Online: September 11, 2023. doi:10.1001/jamainternmed.2023.2457

Conflict of Interest Disclosures: None reported.

References

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Li B , Yang J , Zhao F , et al. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clin Res Cardiol. 2020;109(5):531-538. doi:10.1007/s00392-020-01626-9 PubMed Google Scholar Crossref

Zagidullin N , Musin T , Bagmanova Z , et al. Osborn wave in ECG as a predictor of hospital mortality in COVID-19 associated pneumonia. J Am Coll Cardiol. 2021;77(18):3098. doi:10.1016/S0735-1097(21)04453-3 Google Scholar Crossref

Aizawa Y , Tamura M , Chinushi M , et al. Idiopathic ventricular fibrillation and bradycardia-dependent intraventricular block. Am Heart J. 1993;126(6):1473-1474. doi:10.1016/0002-8703(93)90550-S PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.