Cardiovascular system evaluation and analysis of ecg findings of patients hospitalized from the emergency department DUE to COVID-19 infection

Objective: The purpose of this study is to investigate the electrocardiographic changes, cardiac involvement, anatomical regions of involvement, frequency of cardiac events, incidence of existing arrhythmias, and the impact of these factors on prognosis in patients who have recovered from COVID-19 infection. Additionally, we aim to explore the effect of medications used in the treatment of cardiac events on outcomes. Material and Method: The data of COVID-19 patients who applied to Çukurova University Medical Faculty Hospital Emergency Service between 11 March 2020 and 1 December 2022 were retrospectively analyzed. The data of patients who applied to the emergency department with symptoms of COVID-19, whose infection was confirmed by laboratory (with PCR positivity) and who were hospitalized afterwards were recorded. ECG findings, echocardiographic data, development of arrhythmia, diagnosis of acute coronary syndrome, pericarditis, myocarditis, need for urgent invasive imaging, the outcome of emergency angiography, outcome of the patients and hospitalization were evaluated during admission and hospitalization. Results: The median age of the patients was 70 years and the male ratio was 61.4%, while the female ratio was 38.6%. Seventy percent of the patients had a GCS score of 15 at the time of their first admission to the emergency department. The rate of patients with delirium was found to be 18.6%. The rate of patients with co-morbidities was 85.7%, and the most common co-morbidities were hypertension (58.6%), coronary artery disease (52.9%) and diabetes mellitus (44.3%), respectively. Sinus tachycardia (60%) was the most common rhythm observed on ECG. After sinus tachycardia, atrial fibrillation was the most common (31.4%) respectively. The most common findings in patients who underwent echocardiography were low EF with 54.3% and normal EF with 45.7%. Pericardial effusion was detected in 44.3% of the patients. The mean ejection fraction was found to be 50.3±11.5. The rate of patients admitted to the intensive care units was 72.9%. At the end of the treatment period, the death rate was found to be 38.6%. The mean stay of length was 14.8±9.7 days. While the median NEWS 2 score obtained from the patients at the time of admission to the emergency department was 9, the median VACO index score was 15.2. It was observed that there was no statistically significant difference between the patients who died and those who survived in terms of vital signs (p>0.05). It was determined that the mean GCS scores of the patients who lost their lives at the time of admission to the emergency department were significantly lower (p=0.001). In addition, it was determined that the surviving patients were mostly conscious patients (p=0.005). The rate of delirium detection was statistically significantly higher in patients who died than in patients who survived (p=0.012). It was observed that there was no significant relationship between the presence of additional disease and mortality (p>0.05). It was observed that mortality rate was higher only in patients with malignancy (p=0.002). It was observed that the presence of additional disease prolonged the duration of hospitalization (p=0.022). Patients with peripheral embolism were found to be hospitalized for longer periods (p=0.036). Although the NEWS 2 and VACO scores of the patients who lost their lives during their follow-up were higher than the survivors, recorded at the time of their first admission to the emergency department, only the elevation in the NEWS 2 scores was statistically significant (p=0.008 and p=0.077, respectively). It was determined that ECG and ECHO findings were not statistically significantly correlated with mortality and hospitalization days (p>0.05). Conclusion: Although changes in consciousness, delirium, and low GCS levels were associated with mortality in COVID-19 patients, there was no significant correlation between mortality and ECG or ECHO findings among those who required hospitalization. Therefore, in COVID-19 patients who are admitted to the hospital after presenting to the emergency department, the presence of delirium and low GCS levels should be considered as poor prognostic criteria, and they should not be overlooked as potential markers of mortality. Key Words: Emergency room, COVID-19, Echocardiography, Electrocardiography, Prognosis