Heart complications uncommon, treatable in children with COVID-19

Heart complications in children and young adults infected with COVID-19 are uncommon but treatable, according to a new science report summarizing what's known about how to treat, manage and prevent cardiovascular complications from the coronavirus in youth.

The scientific statement from the American Heart Association, published Monday in its journal Circulation, also calls for more research on the short- and long-term cardiovascular effects from COVID-19 in people under 30.

"Although much has been learned about how the virus impacts children's and young adult's hearts, how to best treat cardiovascular complications and prevent severe illness and continued clinical research trials are needed to better understand the long-term cardiovascular impacts," Dr. Pei-Ni Jone said in a news release. Jone is chair of the statement writing group and director of 3D Echocardiography, the Kawasaki Disease Clinic and Quality in Echocardiography at Children's Hospital Colorado in Aurora.

Children infected with the coronavirus usually experience mild symptoms, the report said. As of Feb. 24, children accounted for about 17.6% of total COVID-19 cases in the U.S. and about 0.1% of deaths, according to Centers for Disease Control and Prevention data cited in the report. Young adults ages 18 to 29 accounted for 21.3% of COVID-19 cases and 0.8% of deaths. The research suggests children may be less susceptible to severe COVID-19 because their cells have fewer receptors for the virus to attach to and they may have a lower immune response than adults.

Heart complications are uncommon in children with COVID-19 infections. However, some may experience abnormal heartbeats, inflammation in and around the heart muscle or cardiogenic shock, which occurs when a suddenly weakened heart can't pump enough blood to meet the body's needs. Children with severe illness from COVID-19 that affected the heart have suffered sudden cardiac death or have died following intensive medical or life support treatment.

Children with mild or no symptoms can safely return to sports after they recover from an infection, the report said. Those experiencing more severe illness should have heart exams that include an echocardiogram, blood tests of heart enzyme levels and other screenings for proper heart function before resuming sports or strenuous physical exercise.

Rarely, children with COVID-19 develop a condition called multisystem inflammatory syndrome in children, or MIS-C, that can cause inflammation of the heart muscle or arteries. This can be treated with intravenous immunoglobulin alone or as dual therapy with infliximab or other immunomodulatory agents. Most children recover within four weeks.

The statement pointed out that research shows COVID-19 vaccines reduce the risk of MIS-C by up to 91% and help protect children from infection. An analysis of the data indicates the benefits of vaccination outweigh any risk of developing rare vaccine-associated heart inflammation called myocarditis. Research estimated that 1 million doses of the mRNA COVID-19 vaccine to boys and men ages 12 to 29 – the highest-risk group for developing myocarditis – would prevent an estimated 11,000 infections, 560 hospitalizations and six deaths, while causing 39 to 47 cases of myocarditis.

The statement outlines available treatments for children with COVID-19, including antiviral drugs remdesivir and dexamethasone for children in certain age groups.

The statement also looked at COVID-19's impact on special populations. It said children with congenital heart defects appear to have low infection rates and deaths from the virus, while those with underlying genetic syndromes, such as Down syndrome, have a higher risk of severe disease if infected.

"It is also important to address health disparities that have become more apparent during the pandemic," Jone said. "We must work to ensure all children receive equal access to vaccination and high-quality care."

The statement calls for further research into treatment of COVID-19, vaccine-associated myocarditis; the long-term outcomes of both COVID-19 and MIS-C; and the impact of these conditions on heart health for children and young adults. It also calls for clinical trials of new antiviral therapies for children.

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