Patient continues to be in haemodynamically stable sinus bradycardia with intermittent episodes of accelerated idioventricular rhythm. Patient develops numerous episodes of accelerated idioventricular rhythm with associated hypotension however, he does not require initiation of vasopressors due to prompt conversion to haemodynamically stable sinus rhythm. Sedation is changed from propofol to ketamine without improvement in heart rate. Transthoracic echocardiogram does not demonstrate any structural or functional abnormalities. Patient develops new sinus bradycardia (rate 51 b.p.m.) but remains haemodynamically stable. COVID-19 is diagnosed.Intubated for acute hypoxic respiratory failure Patient presents with 7 days of fever, cough, and congestion after recent travel. Patient is extubated and remains in sinus bradycardia. Patient remains haemodynamically stable in sinus bradycardia. Midazolam is changed to ketamine with improvement in MAP. Sedation is changed from propofol to midazolam without improvement in heart rate.Įpinephrine is weaned but the patient becomes hypotensive and does not have a compensatory rise in heart rate. Epinephrine infusion is started with improvement of MAP to 65 mmHg. Patient develops new sinus bradycardia (rate 38 b.p.m.) with decrease in mean arterial blood pressure (MAP) to a nadir of 50 mmHg. Intubated for acute hypoxic respiratory failure. Patient presents with 10 days of fever, congestion, and dry cough. 5 In this report, we describe two cases of COVID-19-associated pathological sinus node dysfunction (SND) ( Table 1). 2, 4 To date, persistent inappropriate sinus bradycardia associated with COVID-19 has not been reported. 3 Recent studies have demonstrated that COVID-19 is associated with direct myocardial injury, and affected patients are at risk for cardiovascular complications including acute myocardial infarction, myocarditis, heart failure, cardiogenic shock, and cardiac arrest. 1, 2 During the SARS-CoV epidemic that began in 2002, significant sinus bradycardia occurred in 15% of patients, with a mean heart rate of 43 beats per minute (b.p.m.) and an average duration of 2.6 days.
1 Along with respiratory distress, COVID-19 causes significant cardiovascular dysfunction in patients with, and without, pre-existing cardiovascular disease. Novel coronavirus disease-19 (COVID-19) is a global pandemic caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2).
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