Atrioventricular and Sinus Node Dysfunction in Stable COVID-19 Patients
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COVID-19
Atrioventricular and Sinus Node Dysfunction in Stable COVID-19 Patients Savalan Babapoor-Farrokhran 1 & Uyanga Batnyam 1 & Philip C. Wiener 1 & Napatt Kanjanahattakij 1 & Ola Khraisha 1 & Aman Amanullah 1,2 & Sumeet K. Mainigi 1,2 Accepted: 28 August 2020 # Springer Nature Switzerland AG 2020
Abstract There are now well-documented cardiac complications of COVID-19 infection which include myocarditis, heart failure, and acute coronary syndrome resulting from coronary artery thrombosis or SARS-CoV-2-related plaque ruptures. There is growing evidence showing that arrhythmias are also one of the major complications. We report two patients with no known history of cardiac conduction disease who presented with COVID-19 symptoms, positive SARS-CoV-2 infection, and developed cardiac conduction abnormalities. Cardiac conduction system disease involving the sino-atrial (SA) node and atrioventricular (AV) node could be a manifestation of SARS-CoV-2 infection. Keywords Sinus node dysfunction . Atrioventricular block . Bradycardia . COVID-19 . Arrhythmia
Introduction
Case Presentation
There are now well-documented cardiac complications of COVID-19 infection which include myocarditis, heart failure, and acute coronary syndrome resulting from coronary artery thrombosis or SARS-CoV-2-related plaque ruptures [1, 2]. However, there is growing evidence showing that arrhythmias are also one of the major complications. Liu et al. reported that about 7% of patients report palpitations as a presenting symptom [3]. In a recent report from Wuhan, China, 16.7% of hospitalized and 44.4% of ICU patients with COVID-19 had cardiac arrhythmias [4]. To date, there have not been reports of reversible sinus node and atrioventricular nodal dysfunction associated with COVID-19 in stable patients. This case series describes clinical characteristics of COVID-19 patients who presented with reversible bradycardia.
Patient 1
This article is part of the Topical Collection on COVID-19 * Savalan Babapoor-Farrokhran [email protected] 1
Division of Cardiology, Department of Medicine, Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19141, USA
2
Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
A 69-year-old woman with a history of hypertension, hyperlipidemia, diabetes mellitus type 2, cerebrovascular accident, and asthma who presented to our institution with symptoms of headaches, shortness of breath, cough, sweating, and generalized body aches. Initial vital signs were an oral temperature of 36.8 °C (98.6 °F), a heart rate of 54 beats per minute (bpm), a blood pressure of 220/96 mmHg, and a respiratory rate of 24 breaths per minute. Significant lab work included positive reverse transcriptase polymerase chain reaction (RT-PCR) testing for SARS-CoV-2. Electrolytes including potassium and magnesium were within normal limits. Renal function and troponin-I were normal. Due to her hypertensive urgency, she was treated briefly with nicardipine infusion and transitioned to oral amlodipine an
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