Cardiac arrhythmias in COVID-19 infection

SM Kochav, E Coromilas, A Nalbandian… - Circulation …, 2020 - Am Heart Assoc
SM Kochav, E Coromilas, A Nalbandian, LS Ranard, A Gupta, MK Chung, R Gopinathannair
Circulation: arrhythmia and electrophysiology, 2020Am Heart Assoc
A 76-year-old man with a history of diabetes mellitus type II and hypertension presented with
progressive dyspnea, weakness, and myalgias for 6 days. On admission, vital signs were
remarkable for a blood pressure of 130/61 mm Hg, heart rate of 44 bpm, and oxygen
saturation at 76% on room air, which improved to 93% with a nonrebreather mask. Chest
radiography (CXR) demonstrated multifocal pneumonia and an enlarged cardiac silhouette
(Figure 1A). Transthoracic echocardiography showed normal left ventricle ejection fraction …
A 76-year-old man with a history of diabetes mellitus type II and hypertension presented with progressive dyspnea, weakness, and myalgias for 6 days. On admission, vital signs were remarkable for a blood pressure of 130/61 mm Hg, heart rate of 44 bpm, and oxygen saturation at 76% on room air, which improved to 93% with a nonrebreather mask. Chest radiography (CXR) demonstrated multifocal pneumonia and an enlarged cardiac silhouette (Figure 1A). Transthoracic echocardiography showed normal left ventricle ejection fraction (LVEF), and initial ECG demonstrated sinus bradycardia with high-grade atrioventricular block with likely atrioventricular Wenckebach and a right bundle branch block (Figure 1B). Admission labs were notable for high-sensitivity troponin T (hs-TropT) of 36 ng/L, creatinine of 1.5 mg/dL, venous lactate of 2.0 mmol/L, normal electrolyte levels, and elevated inflammatory markers (ferritin 1091 ng/mL, CRP [C-reactive protein] 69 ng/L). SARS-CoV-2 testing was positive. Continuous intravenous dopamine infusion was initiated, and the patient’s heart rate improved with resolution of the complete heart block. He was found to have a deep vein thrombosis and started on systemic anticoagulation. He developed progressive hypoxemia, requiring intubation and intensive care unit admission, where he ultimately expired. This patient presented with hypoxemic respiratory failure and atrioventricular block complicated by renal and hepatic dysfunction, which improved with dopamine infusion. Temporary venous pacing was not chosen as firstline therapy due to constraints regarding need for an
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