Cardiovascular Journal of Africa: Vol 32 No 6 (NOVEMBER/DECEMBER 2021)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 6, November/December 2021 AFRICA 297 Cardiac manifestation of corona virus disease 2019: a preliminary report GT Lasisi, AO Duro-Emanuel, TE Akintomide, JO Ologunja, OE Amah Abstract Background: Corona virus disease 2019 (COVID-19) is a multi-systemic illness that can present with cardiac compli- cations. This report describes the preliminary findings of cardiac manifestations seen in patients managed in three centres in Lagos, Nigeria. Methods: Ten patients, part of an ongoing study of patients admitted in three centres in Lagos, Nigeria, with COVID-19 diagnosed with reverse transcriptase polymerase chain reac- tion (RT-PCR) or serology were retrospectively studied for cardiac manifestations. Results: The mean (SD) age was 52.5 ± 18.79 years (with a minimum of 17 years and maximum of 79 years). Six patients were female and four were male. Hypertension was seen in 70%, diabetes in 50% and obesity in 60% of patients. All had elevated inflammatory markers. Only four patients had bilateral pneumonia. The rest had only cardiac manifesta- tions. Six patients presented with de novo heart failure and one had decompensated heart failure. A set of three patients had individually fulminant myocarditis, probable pulmonary embolism and stress cardiomyopathy, respectively. Conclusion: This study shows that co-morbidities are common in patients with COVID-19 and cardiac complications. The array of cardiac complications is large, with the commonest being heart failure. Keywords: COVID-19, corona virus, SARS-Cov-2, heart failure, myocarditis, stress cardiomyopathy Submitted 20/8/20, accepted 4/12/20 Published online 14/1/21 Cardiovasc J Afr 2021; 32 : 297–300 www.cvja.co.za DOI: 10.5830/CVJA-2020-061 In December 2019, a cluster of pneumonia was reported in Wuhan China. 1 This was found to be due to a novel corona virus infection named severe acute respiratory corona virus-2 (SARS- Cov-2) infection. 2 The World Health Organisation (WHO) declared the infection a pandemic by 30 January 2020. 3 SARS-Cov-2 is an envelope RNA virus that belongs to the corona virus family. 4 It comprises four structural proteins known as spike (S), envelope (E), membrane (M) and nucleocapsid (N). 5 It is a highly contagious virus transmitted mainly by droplets. The virus enters the human body through the binding of the viral S protein to angiotensin converting enzyme receptor-2 (ACE-2) on the host cell. 6,7 The ACE-2 receptor is present in large numbers in the lungs, heart, kidneys and gastrointestinal tract. 8,9 It is therefore not surprising that patients come down with respiratory symptoms, cardiac manifestation, acute kidney injury and gastrointestinal symptoms. 10 Patients with pre-morbid conditions, especially cardiovascular conditions, are at risk of severe infection and death. 11,12 The illness caused by SARS-Cov-2 was designated as corona virus disease 2019 (COVID-19) by the WHO. The first case of COVID-19 was reported in Lagos, Nigeria on 27 February 2020. By 14 July 2020, there were 33 616 cases of COVID-19 in Nigeria. The Nigerian Centre for Disease Control (NCDC) guideline stipulates that COVID-19 should be managed in designated isolation centres. However, only confirmed cases are admitted in these isolation centres. Patients with symptoms suggestive of COVID-19 who require admission are treated in any hospital near to their homes, until the infection is confirmed by reverse transcriptase polymerase chain reaction (RT-PCR) assay of a nasopharyngeal swab for SARS-Cov-2. Due to pressure on the healthcare resources, the result of a RT-PCR assay can take up to two weeks. This means patients will essentially be managed by these facilities while awaiting the result of the RT-PCR assay. Here, we report the preliminary findings of an ongoing study of cardiac manifestation of COVID-19 seen in patients admitted in three centres in Lagos, Nigeria. Methods Patients considered for the study were aged at least 14 years (minimum age for admission into the Department of Medicine in the study centres) and admitted in three centres in Lagos, namely General Hospital Ifako-Ijaiye, TAAL Specialist Hospital, Ikeja and 661 Nigerian Airforce Hospital, Ikeja from 1 May 2020 with breathlessness, COVID-19 infection confirmed by RT-PCR nasopharyngeal swab assay or serology, and cardiac abnormality on echocardiography. The RT-PCR assays were done at the Infectious Disease Hospital, Yaba Lagos, Nigeria. The SARS-Cov-2 serology was done using the Wondfo kit produced by Guangzhou WondfoBiothec, China. Other investigations carried out included complete blood count, chemistries, inflammatory marker levels, electrocardiogram (ECG), echocardiography, chest X-ray and in some cases, computerised tomography (CT) scan of the chest. Department of Medicine, General Hospital Ifako-Ijaiye, Lagos, Nigeria GT Lasisi, MB.CHB, FWACP, glasisi@yahoo.com AO Duro-Emanuel, MB BS, FWACP Department of Radiology, General Hospital Ifako-Ijaiye, Lagos, Nigeria TE Akintomide, MB BS, FWACS TAAL Specialist Hospital, Wemabod Estate, Ikeja Lagos, Nigeria JO Ologunja, MB BS 661 Nigerian Air Force Hospital, Ikeja Lagos, Nigeria OE Amah, MB BS