Third-Degree Heart Block Associated With Saddle Pulmonary Embolism: A Rare Sequelae of COVID-19-Induced Hypercoagulable State

Ismail, Zeeshan; Salabei, Joshua K.; Stanger, Greg; Asnake, Zekarias T.; Frimer, Leora; Smock, Andrew

doi:10.7759/cureus.16246

Cited by 6 publications

(5 citation statements)

References 14 publications

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“…In our patient's case, she had a saddle PE, first-degree heart block, Mobitz type II second-degree heart block, and RBBB, which resolved from thrombolytic therapy with no long-standing EKG changes. Other cases similarly found resolution of complete heart block after treatment of PE [ 10 , 11 ]. Our patient had no prior history of conduction system disease, which may be a factor in the full resolution of the AV block caused by PE.…”

Section: Discussionmentioning

confidence: 83%

A Rare Case of Transient Second-Degree Mobitz Type II Heart Block Complicating a Saddle Pulmonary Embolism

Ghallab¹,

Tran²,

Shahid³

et al. 2023

Cureus

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Presentations of pulmonary embolism (PE) are often associated with various cardiac arrhythmias and conduction abnormalities detected on electrocardiograms (EKG). We describe a 65-year-old female with no known history of heart disease or arrhythmias who presented with an acute onset of shortness of breath. Initial EKG showed right bundle branch block (RBBB), and first-degree atrioventricular (AV) block with subsequent development of second-degree Mobitz type II AV block. The patient's clinical appearance was highly suggestive of a massive pulmonary embolism with hemodynamic instability, and treatment with alteplase (tPA) was given, followed by heparinization. A CT pulmonary angiography confirmed the provisional diagnosis and revealed a large saddle embolus within the right and left main pulmonary arteries. Subsequent EKG showed resolution of the RBBB, first-degree AV block, and second-degree AV block. The patient improved clinically and was discharged to a subacute rehab facility with follow-up appointments. This case highlights that pulmonary embolism may present with many EKG changes, including RBBB, firstdegree, second-degree, or complete heart block. Early recognition of PE and thrombolytic treatment can improve cardiac function and restore heart rhythms. Further evaluation for underlying conduction abnormalities can later be performed.

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Section: Discussionmentioning

confidence: 83%

A Rare Case of Transient Second-Degree Mobitz Type II Heart Block Complicating a Saddle Pulmonary Embolism

Ghallab¹,

Tran²,

Shahid³

et al. 2023

Cureus

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“…Other histological analyses in critically ill patients have revealed myocardial interstitial edema expanding into the spaces of the cardiac muscles and evidence of small vessel vasculitis with neutrophilic, and lymphocytic obstruction in the lumen and blood vessel walls [ 15 ]. Furthermore, international post-mortem studies have revealed evidence of lymphocytic myocarditis and widespread macrophage infiltration in the myocardium [ 16 ]. These results are highly suggestive of COVID-19-mediated endothelial injury and cardiac myocyte injury.…”

Section: Discussionmentioning

confidence: 99%

COVID-19-Induced Complete Heart Block: Case Series and Literature Review

Bassi¹,

Ismail²,

Salabei³

et al. 2023

Cureus

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The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has led to the emergence of a wide range of complications, including those affecting the cardiovascular system. In this case series, we present four patients who developed complete atrioventricular block, a serious and potentially lifethreatening heart rhythm disorder, during the course of their coronavirus disease 2019 (COVID-19) illness. The mechanisms by which SARS-CoV-2 may lead to arrhythmias are not fully understood but may involve direct infection and damage to heart tissue, as well as inflammation and cytokine storms. The extent and duration of complete heart block varied among these cases, highlighting the need for further research to understand the spectrum of disease and to improve mortality and morbidity in future waves of SARS-CoV-2 infections. We hope that this case series will draw attention to this serious complication of COVID-19 and inspire further research to improve management and outcomes for affected patients.

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“…block) occurring in up to 24.9% of patients. [60,61]. There are several anecdotal records of patients who have a sudden cardiac arrest from pulse-less electrical activity or complete heart block while being either evaluated for or treated for COVID-19 infection.…”

Section: Complete Heart Block Covid-19 and Cardiac Arrestmentioning

confidence: 99%

“…It has been suggested that direct viral infiltration of cardiomyocytes through the angiotensin-converting enzyme-2 receptors and subsequent systemic inflammation may be one mechanism of cardiac injury. [60]…”

Section: Complete Heart Block Covid-19 and Cardiac Arrestmentioning

confidence: 99%

Clinical Predictors of Cardiac Arrest in COVID 19 Patients with History of Heart Failure

Marwaha,

Mahata,

Kumar

et al. 2023

Preprint

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The COVID-19 pandemic has impacted the healthcare system across the globe, leading to more than 6.9 million deaths in the past four years. Cardiac Arrest is a terminal event with associated significantly high morbidity and mortality across age groups. Multiple clinical parameters, organ dysfunction, and chronic co-morbid conditions impact mortality in COVID-19 patients with heart failure. In this retrospective, administrative dataset-based study on 148899 patients admitted to the hospital with COVID-19 and heart failure diagnosis, we reported 6703 cardiac arrests and 5783 mortality. We have used ICD 10 codes to identify the diagnosis. The primary objective of the study is to find the predictors of Cardiac Arrest among patients admitted to hospitals with COVID-19 and heart failure. Secondary objective is to calculate the percentage of cardiac Arrest and mortality across the various age groups and the correlation of hours on the mechanical ventilator and mortality. Study results have shown that the use of a mechanical ventilator has the strongest co-correlation with cardiac Arrest with an odd ratio of 14.4, followed by septic shock with an odd ratio of 5.6, tension pneumothorax with an odd ratio of 4.9 preceding the acute renal failure with an odd ratio of 2.4 and sepsis 2.3. Complete heart block had an odd ratio of 1.9, followed by ESRD with a ratio of 1.6, acute pulmonary embolism with an odd ratio of 1.5, and Type 2 MI with an odd ratio of 1.49. Chronic co-morbid condition of DM had an odd ratio of 1.3, followed by Atrial fibrillation with an odd ratio of 1.1. These results and findings emphasized that multi-organ failure has a huge impact on cardiac Arrest among COVID-19 patients with heart failure.

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Third-Degree Heart Block Associated With Saddle Pulmonary Embolism: A Rare Sequelae of COVID-19-Induced Hypercoagulable State

Cited by 6 publications

References 14 publications

A Rare Case of Transient Second-Degree Mobitz Type II Heart Block Complicating a Saddle Pulmonary Embolism

A Rare Case of Transient Second-Degree Mobitz Type II Heart Block Complicating a Saddle Pulmonary Embolism

COVID-19-Induced Complete Heart Block: Case Series and Literature Review

Clinical Predictors of Cardiac Arrest in COVID 19 Patients with History of Heart Failure

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