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Misra et al. Vessel Plus 2022;6:14 https://dx.doi.org/10.20517/2574-1209.2021.89 Page 5 of 11

Figure 1. Left main coronary dilation in a patient with multisystem inflammatory syndrome in children. *Dilated left main coronary
artery.

Figure 2. Moderate mitral regurgitation in a patient with multisystem inflammatory syndrome in
children.
A large cohort of 63 patients described low amplitude QRS and transient T-wave inversion as the most
[25]
[25]
common electrocardiographic abnormality . Transient QTc prolongation was seen in 22% of patients .
Only 2/63 patients had atrial arrhythmias, with 11/63 experiencing a bradyarrhythmia . ST-segment
[25]
changes were rarely seen, affecting 5/63 . Figures 4 and 5 show the various electrocardiogram (EKG)
[25]
manifestations of two of our patients who required ECMO support.
In the setting of myocardial inflammation, as is seen in MIS-C, electrocardiographic changes are expected.
While most patients appear to have non-specific and transient changes on electrocardiogram, providers
must be prepared that some will present with significant arrhythmia contributing to circulatory collapse
and/or exacerbating cardiogenic shock.