Case report: Acute type a hepatitis presenting with hypotension, bradycardia, and sinus arrest

Abstract

The cardiovascular complications of viral hepatitis are not widely recognized. Profound hypotension and a variety of dysrhythmias, including sinus arrest, have been reported in association with viral hepatitis, but most of these cases were described before the advent of specific viral serologic markers. Furthermore, previous instances of cardiovascular complications occurred during the course of an established viral syndrome. We report the cases of two previously healthy women who presented with unexplained hypotension and bradycardia as the initial manifestations of acute icteric hepatitis A. This phenomenon appears to represent a variant clinical presentation of a common viral entity.

Complete heart block associated with hepatitis A infection in a female child with fatal outcome

“…Hepatitis A leading to pericarditis, myocarditis, and pleural or pericardial effusion has been reported in the literature but is extremely rare (6,7) . Cases of complete heart block following infectious hepatitis have been published (8) and myocarditis following viral infection can lead to complete heart block (9,10) .…”

Risk of cardiac arrhythmias in patients with chronic hepatitis B and C infections – A 13-year nationwide population-based study

“…In a recent US report of a case-control study using administration data from Veterans Health Administration, an increased risk of incident AF was found in patients with HCV compared to controls, and the hazard ratio of newly diagnosed AF was 1.42 times higher in patients with HCV [18]. In addition, the presentations of hypotension, bradycardia, and sinus arrest during the acute phase of viral hepatitis have been documented, and may require the implantation of a pacemaker for treatment [19]. Sinus node dysfunction (SND) and atrial arrhythmias were frequently found to associate with each other and thereby coexist, interact, initiate, and perpetuate each other [20].…”

Unusual cardiac features in cholestatic hepatitis A in an adolescent: Improvement with corticosteroid treatment

“…Cardiac manifestations such as profound hypotension and a variety of dysrhythmias have been rarely reported in adult patients with hepatitis A. 3,4 We describe an adolescent with acute hepatitis A infection who developed bradycardic episodes and a transient hypotension during the course of acute infection.…”