Cardiac Arrhythmias in COVID-19 Infection

Kochav, Stephanie M.; Coromilas, Ellie J.; Nalbandian, Ani; Ranard, Lauren S.; Gupta, Aakriti; Chung, Mina K.; Gopinathannair, Rakesh; Biviano, Angelo; Garan, Hasan; Wan, Elaine

doi:10.1161/circep.120.008719

Cited by 130 publications

(148 citation statements)

References 19 publications

(21 reference statements)

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“…2 Although the data on arrhythmogenic events are anecdotal, the most commonly reported arrhythmias in COVID-19 patients include atrial fibrillation (AF), atrial flutter, monomorphic or polymorphic ventricular tachycardia, atrioventricular heart block, and pulseless electrical activity. 3 Several recent reports have suggested an increased risk of QT prolongation and subsequent risk of life-threatening ventricular arrhythmias, particularly torsade de pointes (TdP), in COVID-19 patients who received pharmacologic treatment with hydroxychloroquine/chloroquine and azithromycin. 1 We report the case of a 75-year-old patient with a baseline prolonged QT interval in whom the COVID-19 illness resulted in further remarkable prolongation of QT interval (>700 ms), leading to fatal ventricular arrhythmias and death, in the absence of pharmacological treatment with hydroxychloroquine/ azithromycin.…”

Section: Introductionmentioning

confidence: 99%

Prolonged QT Interval in a Patient With Coronavirus Disease-2019: Beyond Hydroxychloroquine and Azithromycin

Anupama

Adhikari

Chaudhuri

2020

Journal of Investigative Medicine High Impact Case Reports

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Recent reports have suggested an increased risk of QT prolongation and subsequent life-threatening ventricular arrhythmias, particularly torsade de pointes, in patients with coronavirus disease-2019 (COVID-19) treated with hydroxychloroquine and azithromycin. In this article, we report the case of a 75-year-old female with a baseline prolonged QT interval in whom the COVID-19 illness resulted in further remarkable QT prolongation (>700 ms), precipitating recurrent self-terminating episodes of torsade de pointes that necessitated temporary cardiac pacing. Despite the correction of hypoxemia and the absence of reversible factors, such as adverse medication effects, electrolyte derangements, and usage of hydroxychloroquine/azithromycin, the QT interval remained persistently prolonged compared with the baseline with subsequent degeneration into ventricular tachycardia and death. Thus, we highlight that COVID-19 illness itself can potentially lead to further prolongation of QT interval and unmask fatal ventricular arrhythmias in patients who have a prolonged QT and low repolarization reserve at baseline.

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Section: Introductionmentioning

confidence: 99%

Prolonged QT Interval in a Patient With Coronavirus Disease-2019: Beyond Hydroxychloroquine and Azithromycin

Anupama

Adhikari

Chaudhuri

2020

Journal of Investigative Medicine High Impact Case Reports

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“…Even though our patient was given anticoagulation therapy, given a CHA2DS2-VASc score of four, patients with COVID-19 may be prone to increased thromboembolic risk given elevated D-dimer levels, which should be considered during the decision-making regarding anticoagulation initiation for AF, even in the presence of a low CHA2DS2-VASc score [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

A Case of Isolated Dysarthria in a COVID-19 Infected Stroke Patient: A Nondisabling Neurological Symptom With Grave Prognosis

Bhagat¹,

Narayanan²,

Karki³

et al. 2020

Cureus

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Isolated dysarthria is a speech abnormality characterized by slurring without any language dysfunction, or other neurological deficits. In an acute setting, it is commonly associated with stroke. In the context of social distancing during the current corona virus disease 2019 (COVID-19) pandemic, nondisabling symptoms such as isolated dysarthria can delay a patient's perception to seek immediate medical care. We present a rare case of isolated dysarthria in a COVID-19 infected stroke patient with a grave prognosis. A 79-year-old African American male presented with isolated dysarthria that manifested two days prior to his hospital visit. The dysarthria assessment showed impaired articulation, phonation, and prosody. Other neurological examinations were normal. He tested positive for the COVID-19 infection. His pulmonary CT scan showed bilateral ground glass opacities. An electrocardiogram showed atrial fibrillation (AF). Brain MRI revealed a punctate acute infarction in the left frontal lobe. Initially, he was treated with IV anticoagulation, oral beta-blocker, azithromycin and hydroxychloroquine, but he dramatically deteriorated within a week exhibiting a highly elevated cytokine level eventually resulting in multi-system organ failure. Despite aggressive treatment with steroids, tocilizumab and other supportive measures, the patient died of cardiac arrest. Our case highlights that acute stroke could manifest as an isolated dysarthria, which is an indicator of increased severity and high mortality with COVID-19 infection. Public awareness about the stroke symptom awareness should be emphasized.

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“…Another brief case series demonstrated exemplary situations of patients with high-grade atrioventricular block, atrial fibrillation, polymorphic ventricular tachycardia and pulseless electrical activity (14). Authors concluded that reported arrhythmia complications did not correlate with severity of lung infection on chest radiograph.…”

Section: Global Perspective Of Arrhythmia In Current Pandemicmentioning

confidence: 97%

Arrhythmias in COVID-19: clinical significance and management

Yontar¹,

Zengin²

2020

HVT

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Worldwide spread of coronavirus disease (COVID-19) caused overwhelming mortality rate during preceding half of the year 2020. Although coronavirus infection was known for mostly respiratory tract involvement, novel COVID-19 pandemic showed excessive cardiac mortality and arrhythmic complications. We aimed to summarize current literature and emphasize on underlying pathological mechanisms and global point of view to coronavirus and arrhythmia relationship. Key words: Coronavirus, COVID-19, arrhythmia

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Cardiac Arrhythmias in COVID-19 Infection

Cited by 130 publications

References 19 publications

Prolonged QT Interval in a Patient With Coronavirus Disease-2019: Beyond Hydroxychloroquine and Azithromycin

Prolonged QT Interval in a Patient With Coronavirus Disease-2019: Beyond Hydroxychloroquine and Azithromycin

A Case of Isolated Dysarthria in a COVID-19 Infected Stroke Patient: A Nondisabling Neurological Symptom With Grave Prognosis

Arrhythmias in COVID-19: clinical significance and management

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