Polymorphic Ventricular Tachycardia with a Normal QTc Interval in a Patient with COVID-19 and Fever: Case Report
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COVID-19
Polymorphic Ventricular Tachycardia with a Normal QTc Interval in a Patient with COVID-19 and Fever: Case Report Savalan Babapoor-Farrokhran 1
&
Zachary Port 1 & Philip C. Wiener 1 & Aman Amanullah 1,2 & Sumeet K. Mainigi 1,2
Accepted: 17 September 2020 # Springer Nature Switzerland AG 2020
Abstract Arrhythmias or conduction system disease are not the most common manifestation of COVID-19 infection in patients requiring hospital admission. Torsade de pointes typically occurs in bursts of self-limiting episodes with symptoms of dizziness and syncope. However, it may occasionally progress to ventricular fibrillation and sudden death. In this article, we report a case of COVID-19 patient who developed polymorphic ventricular tachycardia with torsade de pointes morphology with normal QTc interval in the setting of fever. An 81-year-old woman was admitted with symptoms of COVID-19. She was treated with hydroxychloroquine, azithromycin, and doxycycline at an outside facility and finished the treatment 5 days prior to admission to our facility. Her course was complicated by atrial fibrillation with rapid ventricular response requiring cardioversion. Later, she developed two episodes of polymorphic ventricular tachycardia with TdP morphology with normal QTc. There was a correlation with fever triggering the ventricular tachycardia. We advocated aggressive fever control given the QTc was normal and stable. Following fever control, the patient remained stable and had no abnormal rhythm. COVID-19 patients are prone to different arrhythmias including life-threatening ventricular arrhythmias with normal left ventricular systolic function and normal QTc, and they should be monitored for fever and electrolyte abnormality during their hospital stay. Keywords Polymorphic ventricular tachycardia . Torsade de pointes . Arrhythmias . COVID-19 . Severe acute respiratory syndrome coronavirus-2
Introduction COVID-19 is considered to be a multi-organ system disease that can cause lung, liver, kidney, nervous system, and reproductive system damage [1]. Arrhythmias or conduction system disease are not the most common manifestation of COVID-19 infection in patients requiring hospital admission. Myocardial injury is common in critically ill COVID-19 individuals as a result of different plausible mechanisms including direct damage to the cardiomyocytes, systemic inflammation, interferon-mediated immune response, exaggerated cytokine
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
response by types 1 and 2 helper T cells, coronary plaque destabilization, and hypoxia [2, 3]. Ventricular arrhythmia may be either monomorphic with a single QRS morphology or polymorphic with QRS morphology varying in amplitude, axis, and duration. The most common cause of pol
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