Heart problems after COVID-19 are rare in children and young adults and require further study-ScienceDaily

The latest data also show that after the heart symptoms have disappeared, return to sports and intense physical activity is safe, but if additional screening is considered for adolescents experiencing more severe symptoms. there is.

The new statement also calls for more research, including studies investigating the long-term cardiovascular effects of COVID-19 in children and young adults. Extensive research by a group of volunteer authors on the latest data shows that children with congenital heart disease (heart disease or defects present at birth) are associated with infection rates with SARS-CoV-2, the virus that causes COVID-19 disease. It turned out that the incidence of the disease was low. The scientific statement from the American Heart Association is an analysis by current research experts and may serve as a guide for the future.

“Two years after the pandemic, a huge amount of research was done on children with COVID-19, and this statement tells us what we know so far in relation to children’s COVID-19. “I’m summarizing,” said the statement-writing group Pei-Ni Jone, MD chairman. , FAHA, Director of Quality 3D Echocardiography, Kawasaki Disease Clinic and Echocardiography, Colorado Children’s Hospital, Aurora, Colorado. “”We focused on the latest data on the effects of this virus on people with congenital or other heart disease, and the potential association of the COVID-19 vaccine with heart complications in children and young adults. As we all know, this public health emergency requires ongoing research to understand its short-term and long-term consequences for children. “

According to the analysis of the latest research, children generally show mild symptoms due to SARS-CoV-2 infection. In the United States, as of February 24, 2022, children accounted for 17.6% of all COVID-19 cases and about 0.1% of viral deaths. In addition, young adults between the ages of 18 and 29 account for 21.3% of cases and 0.8% of deaths from COVID-19. Studies show that there are several factors that may help explain why children are less susceptible to severe COVID-19 infections. 1) The cells in the child’s body have few receptors that attach to the SARS-CoV-2 virus, and 2) the child may have low immunity. Responses with different cytokine responses compared to adults, and trained immunity from other vaccines and viral infections.

Children with congenital heart disease have lower infection and mortality from SARS-CoV-2 infection and are at increased risk of severe COVID if they have an underlying hereditary syndrome such as trisomy 21 (also known as Down’s syndrome). It seems. -19.

The statement does not have a specific COVID-19 antiviral therapy, but outlines the treatments available for children with COVID-19. These include remdesivir and dexamethasone for children of a particular age group. Remdesivir is the only antiviral currently approved by the US Food and Drug Administration (FDA) for the treatment of people over the age of 12 hospitalized with COVID-19, a risk factor for severe illness and the need for oxygen supplementation. It is a viral drug and is the most effective. When given as soon as possible after the onset of symptoms. Dexamethasone, which has been shown to reduce the risk of death in adults with COVID-19, is recommended for children with more serious illnesses who require respiratory support.

Heart-related complications in children with COVID-19 are rare. The case reports of cardiac complications are as follows.

• Cardiogenic shock. A suddenly weakened heart cannot pump enough blood to meet the needs of the body.
• Myocarditis (inflammation of the muscles of the heart); pericarditis (inflammation of the pericardium, a thin sac-like structure surrounding the heart);
• Arrhythmia (arrhythmia and rhythm).

Children with severe COVID-19 who affected the heart experienced sudden cardiac death and death after intensive medical and life-sustaining treatment.

Since the beginning of the COVID-19 pandemic, new multisystem inflammatory syndromes (MIS-C) have been identified worldwide, with half of the cases associated with inflammation of the heart muscle and arteries of the heart. During the first year of the pandemic, one in 3,164 children with SARS-CoV-2 infection developed MIS-C.

Children with MIS-C are given intravenous immunoglobulin (IVIG) alone or as double therapy with infliximab or other immunomodulators. The hearts of most children recovered well within 1 to 4 weeks of MIS-C diagnosis. The risk of long-term complications and death from MIS-C is estimated to be 1.4-1.9%.

The majority of cases of MIS-C were among children identified as black or Hispanic in medical records. Additional research on MIS-C is needed to learn why people of diverse races or ethnic groups are affected by disproportionateness and to understand the risk factors for this condition.

For children and young adults infected with COVID-19, return to sports and intense physical activity are areas of targeted research and research. The latest data suggest that people with mild COVID-19 or asymptomatic infections can safely return to sports after recovering from all symptoms. For young people with more serious SARS-CoV-2 infections, or those with MIS-C, choices such as echocardiography, cardiac enzyme level blood tests, and other cardiac function screenings before returning to sports It is reasonable to consider a cardiovascular screening that has been done.

The COVID-19 vaccine can prevent patients from becoming infected with COVID-19 and reduce the risk of MIS-C in children aged 12-18 years by 91%. Some have expressed concern about the risk of heart inflammation after vaccination with mRNACOVID-19. The data show that the benefits of getting a vaccine outweigh the risk of developing vaccine-related myocarditis. For example, for every 1 million doses of the mRNA COVID-19 vaccine in men aged 12-29 years (the group with the highest risk of vaccine-related myocarditis), 11,000 COVID-19 cases, 560 hospitalizations, 6 patients. Death is estimated. Although prevented, 39-47 cases of myocarditis are expected. The FDA grants an emergency use authorization for the mRNA vaccine manufactured by Pfizer BioNTech for children ages 5 and up, giving full approval to all individuals ages 16 and over.

Viral infections are the most common cause of myocarditis in children. According to data from the Centers for Disease Control and Prevention, one to two in 100,000 people in the United States are diagnosed with myocarditis prior to the COVID-19 pandemic each year. Also, children are more likely to develop myocarditis than adults as a result of viral infections such as COVID-19. The CDC continues to closely track possible associations between myocarditis in children and young adults, especially the mRNA COVID-19 vaccine.

SARS-CoV-2 infection, vaccine-related myocarditis, long-term outcomes of both COVID-19 and MIS-C, and various of these conditions in the minds of children and young adults. In addition, the development of new antiviral therapies should be tested in child-focused clinical trials.

“Much has been learned about how the virus affects the hearts of children and young adults, but how to best treat cardiovascular complications and prevent serious illnesses and the long term. We need ongoing clinical research trials to better understand the cardiovascular effects, “Joan said. “It is also important to address the health inequalities that emerged during the pandemic. We must strive to ensure that all children receive equal vaccination and quality care.”

This scientific statement was produced by a group of volunteer authors on behalf of the American Heart Association’s Council on Lifetime Congenital Heart Diseases and Young Hearts. Hypertension Council; Peripheral Vascular Disease Council. The American Heart Association’s scientific statement helps raise awareness of cardiovascular disease and stroke issues and facilitates informed medical decisions. The scientific statement outlines what is currently known about the topic and areas that require additional research. Scientific statements inform the development of guidelines, but do not recommend treatment. The American Heart Association guidelines provide the association’s official clinical practice recommendations.

Co-authors are Vice-Chair Sarah D. de Ferranti, MD, MPH and FAHA. Anisa John, MD, Ph.D.; Matthew E. Oster, MD, MPH, FAHA; Kiona Allen, MD; Adrianna H. Tremoulet, MD, MAS, FAHA; Elizabeth V. Sarrel, MD, FAHA; Linda M. Lambert, APRN , FAHA; Sherry D. Miyamoto, MD, FAHA. The author’s disclosure is included in the manuscript.