COVID-19 electrocardiogram

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Risk calculators and risk factors for COVID-19 electrocardiogram

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sabawoon Mirwais, M.B.B.S, M.D.[2]; Syed Hassan A. Kazmi BSc, MD [3]; Nuha Al-Howthi, MD[4]


There are no specific ECG findings associated with COVID-19. The ECG findings that have been reported are sinus tachycardia, ST-elevation, diffuse T wave inversion, relative bradycardia, atrial fibrillation.


  • Medication induce prolongation of PQ interval,particularly in those with co-morbidities and in those who are treated with other QT-prolonging medications.[7]

QTc Assessment Guidelines

Table 1. Risk Score For Drug-Associated QTc Prolongation[8]

Risk Factors Points
Age ≥68 y 1
Female sex 1
Loop diuretic 1
Serum K+ ≤3.5 mEq/L 2
Admission QTc ≥450 ms 2
Acute MI 2
≥2 QTc-prolonging drugs 3
sepsis 3
Heart failure 3
One QTc-prolonging drug 3
Maximum Risk Score 21
K+ indicates potassium; and MI, myocardial infarction.

A Tisdale score of ≤ 6 predicts low risk, 7-10 medium risk, and ≥ 11 high risk of drug-associated QT prolongation (Table 2).

Table 2. Risk Levels For Drug-Associated QT Prolongation
Low risk = ≤6 points
Moderate risk = 7-10 points
High-risk = ≥11 points


  1. Alhogbani T (2016). "Acute myocarditis associated with novel Middle east respiratory syndrome coronavirus". Ann Saudi Med. 36 (1): 78–80. doi:10.5144/0256-4947.2016.78. PMC 6074274. PMID 26922692.
  2. 2.0 2.1 2.2 2.3 Amaratunga, Eluwana A; Corwin, Douglas S; Moran, Lynn; Snyder, Richard (2020). "Bradycardia in Patients With COVID-19: A Calm Before the Storm?". Cureus. doi:10.7759/cureus.8599. ISSN 2168-8184.
  3. 3.0 3.1 He, Jia; Wu, Bo; Chen, Yaqin; Tang, Jianjun; Liu, Qiming; Zhou, Shenghua; Chen, Chen; Qin, Qingwu; Huang, Kang; Lv, Jianlei; Chen, Yan; Peng, Daoquan (2020). "Characteristic Electrocardiographic Manifestations in Patients With COVID-19". Canadian Journal of Cardiology. 36 (6): 966.e1–966.e4. doi:10.1016/j.cjca.2020.03.028. ISSN 0828-282X.
  4. 4.0 4.1 Mccullough, S. Andrew; Goyal, Parag; Krishnan, Udhay; Choi, Justin J.; Safford, Monika M.; Okin, Peter M. (2020). "Electrocardiographic Findings in Coronavirus Disease-19: Insights on Mortality and Underlying Myocardial Processes". Journal of Cardiac Failure. doi:10.1016/j.cardfail.2020.06.005. ISSN 1071-9164.
  5. Inciardi, Riccardo M.; Lupi, Laura; Zaccone, Gregorio; Italia, Leonardo; Raffo, Michela; Tomasoni, Daniela; Cani, Dario S.; Cerini, Manuel; Farina, Davide; Gavazzi, Emanuele; Maroldi, Roberto; Adamo, Marianna; Ammirati, Enrico; Sinagra, Gianfranco; Lombardi, Carlo M.; Metra, Marco (2020). "Cardiac Involvement in a Patient With Coronavirus Disease 2019 (COVID-19)". JAMA Cardiology. doi:10.1001/jamacardio.2020.1096. ISSN 2380-6583.
  6. Ye, Qing; Wang, Bili; Mao, Jianhua (2020). "The pathogenesis and treatment of the `Cytokine Storm' in COVID-19". Journal of Infection. 80 (6): 607–613. doi:10.1016/j.jinf.2020.03.037. ISSN 0163-4453.
  7. Chorin, Ehud; Dai, Matthew; Shulman, Eric; Wadhwani, Lalit; Bar-Cohen, Roi; Barbhaiya, Chirag; Aizer, Anthony; Holmes, Douglas; Bernstein, Scott; Spinelli, Michael; Park, David S.; Chinitz, Larry A.; Jankelson, Lior (2020). "The QT interval in patients with COVID-19 treated with hydroxychloroquine and azithromycin". Nature Medicine. 26 (6): 808–809. doi:10.1038/s41591-020-0888-2. ISSN 1078-8956.
  8. Tisdale, James E.; Jaynes, Heather A.; Kingery, Joanna R.; Mourad, Noha A.; Trujillo, Tate N.; Overholser, Brian R.; Kovacs, Richard J. (2013). "Development and Validation of a Risk Score to Predict QT Interval Prolongation in Hospitalized Patients". Circulation: Cardiovascular Quality and Outcomes. 6 (4): 479–487. doi:10.1161/CIRCOUTCOMES.113.000152. ISSN 1941-7713.