Lethal Arrhythmia (Torsade de Pointes) in COVID-19: An Event Synergistically Induced by Viral Associated Cardiac Injury, Hyperinflammatory Response, and Treatment Drug?
Identifieur interne : 000553 ( Main/Corpus ); précédent : 000552; suivant : 000554Lethal Arrhythmia (Torsade de Pointes) in COVID-19: An Event Synergistically Induced by Viral Associated Cardiac Injury, Hyperinflammatory Response, and Treatment Drug?
Auteurs : Nuraini Yasmin Kusumawardhani ; Ian Huang ; Erwan Martanto ; Teddy Arnold Sihite ; Eka Surya Nugraha ; Susantina Prodjosoewojo ; Laniyati Hamijoyo ; Yovita HartantriSource :
- Clinical medicine insights. Case reports [ 1179-5476 ] ; 2020.
Abstract
Arrhythmias in patients with coronavirus disease 2019 (COVID-19) are prevalent and deserve special attention because they are associated with an increased risk of fatal outcome. The mechanism of arrhythmia in COVID-19 remains unclear. Here, we report our first case of confirmed COVID-19 with documented Torsade de Pointes (TdP). A 64-year-old woman, previously healthy, presented to our emergency department with progressive shortness of breath, dry cough, and 1 week of fever. She was treated with chloroquine phosphate, meropenem, and ciprofloxacin. After 5 days of admission, her condition deteriorated and she was admitted to the intensive care unit. The patient had two episodes of malignant arrhythmias within 24 hours. The former was TdP, and the latter was a fatal pulseless ventricular tachycardia that occured even after chloroquine was discontinued. There was evidence of cardiac injury shown by increased serum level of troponin I. We propose a synergistic concept of lethal arrhythmia due to direct severe acute respiratory syndrome coronavirus (SARS-CoV)-2-associated cardiac injury, hyperinflammatory response, and drug-induced arrhythmia.
DOI: 10.1177/1179547620972397
PubMed: 33402858
PubMed Central: PMC7739200
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Erwan" sort="Martanto, Erwan" uniqKey="Martanto E" first="Erwan" last="Martanto">Erwan Martanto</name><affiliation><nlm:affiliation>Department of Internal Medicine, Faculty of Medicine Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia.</nlm:affiliation></affiliation></author><author><name sortKey="Sihite, Teddy Arnold" sort="Sihite, Teddy Arnold" uniqKey="Sihite T" first="Teddy Arnold" last="Sihite">Teddy Arnold Sihite</name><affiliation><nlm:affiliation>Department of Internal Medicine, Faculty of Medicine Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia.</nlm:affiliation></affiliation></author><author><name sortKey="Nugraha, Eka Surya" sort="Nugraha, Eka Surya" uniqKey="Nugraha E" first="Eka Surya" last="Nugraha">Eka Surya Nugraha</name><affiliation><nlm:affiliation>Department of Internal Medicine, Faculty of Medicine Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia.</nlm:affiliation></affiliation></author><author><name sortKey="Prodjosoewojo, Susantina" sort="Prodjosoewojo, Susantina" uniqKey="Prodjosoewojo S" first="Susantina" last="Prodjosoewojo">Susantina Prodjosoewojo</name><affiliation><nlm:affiliation>Department of Internal Medicine, Faculty of Medicine Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia.</nlm:affiliation></affiliation></author><author><name sortKey="Hamijoyo, Laniyati" sort="Hamijoyo, Laniyati" uniqKey="Hamijoyo L" first="Laniyati" last="Hamijoyo">Laniyati Hamijoyo</name><affiliation><nlm:affiliation>Department of Internal Medicine, Faculty of Medicine Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia.</nlm:affiliation></affiliation></author><author><name sortKey="Hartantri, Yovita" sort="Hartantri, Yovita" uniqKey="Hartantri Y" first="Yovita" last="Hartantri">Yovita Hartantri</name><affiliation><nlm:affiliation>Department of Internal Medicine, Faculty of Medicine Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia.</nlm:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2020">2020</date><idno type="RBID">pubmed:33402858</idno><idno type="pmid">33402858</idno><idno type="doi">10.1177/1179547620972397</idno><idno type="pmc">PMC7739200</idno><idno type="wicri:Area/Main/Corpus">000553</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000553</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Lethal Arrhythmia (<i>Torsade de Pointes</i>) in COVID-19: An Event Synergistically Induced by Viral Associated Cardiac Injury, Hyperinflammatory Response, and Treatment Drug?</title><author><name sortKey="Yasmin Kusumawardhani, Nuraini" sort="Yasmin Kusumawardhani, Nuraini" uniqKey="Yasmin Kusumawardhani N" first="Nuraini" last="Yasmin Kusumawardhani">Nuraini Yasmin Kusumawardhani</name><affiliation><nlm:affiliation>Department of Internal Medicine, Faculty of Medicine Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia.</nlm:affiliation></affiliation></author><author><name sortKey="Huang, Ian" sort="Huang, Ian" uniqKey="Huang I" first="Ian" last="Huang">Ian Huang</name><affiliation><nlm:affiliation>Department of Internal Medicine, Faculty of Medicine Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia.</nlm:affiliation></affiliation></author><author><name sortKey="Martanto, Erwan" sort="Martanto, Erwan" uniqKey="Martanto E" first="Erwan" last="Martanto">Erwan Martanto</name><affiliation><nlm:affiliation>Department of Internal Medicine, Faculty of Medicine Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia.</nlm:affiliation></affiliation></author><author><name sortKey="Sihite, Teddy Arnold" sort="Sihite, Teddy Arnold" uniqKey="Sihite T" first="Teddy Arnold" last="Sihite">Teddy Arnold Sihite</name><affiliation><nlm:affiliation>Department of Internal Medicine, Faculty of Medicine Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia.</nlm:affiliation></affiliation></author><author><name sortKey="Nugraha, Eka Surya" sort="Nugraha, Eka Surya" uniqKey="Nugraha E" first="Eka Surya" last="Nugraha">Eka Surya Nugraha</name><affiliation><nlm:affiliation>Department of Internal Medicine, Faculty of Medicine Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia.</nlm:affiliation></affiliation></author><author><name sortKey="Prodjosoewojo, Susantina" sort="Prodjosoewojo, Susantina" uniqKey="Prodjosoewojo S" first="Susantina" last="Prodjosoewojo">Susantina Prodjosoewojo</name><affiliation><nlm:affiliation>Department of Internal Medicine, Faculty of Medicine Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia.</nlm:affiliation></affiliation></author><author><name sortKey="Hamijoyo, Laniyati" sort="Hamijoyo, Laniyati" uniqKey="Hamijoyo L" first="Laniyati" last="Hamijoyo">Laniyati Hamijoyo</name><affiliation><nlm:affiliation>Department of Internal Medicine, Faculty of Medicine Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia.</nlm:affiliation></affiliation></author><author><name sortKey="Hartantri, Yovita" sort="Hartantri, Yovita" uniqKey="Hartantri Y" first="Yovita" last="Hartantri">Yovita Hartantri</name><affiliation><nlm:affiliation>Department of Internal Medicine, Faculty of Medicine Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia.</nlm:affiliation></affiliation></author></analytic><series><title level="j">Clinical medicine insights. Case reports</title><idno type="ISSN">1179-5476</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Arrhythmias in patients with coronavirus disease 2019 (COVID-19) are prevalent and deserve special attention because they are associated with an increased risk of fatal outcome. The mechanism of arrhythmia in COVID-19 remains unclear. Here, we report our first case of confirmed COVID-19 with documented Torsade de Pointes (TdP). A 64-year-old woman, previously healthy, presented to our emergency department with progressive shortness of breath, dry cough, and 1 week of fever. She was treated with chloroquine phosphate, meropenem, and ciprofloxacin. After 5 days of admission, her condition deteriorated and she was admitted to the intensive care unit. The patient had two episodes of malignant arrhythmias within 24 hours. The former was TdP, and the latter was a fatal pulseless ventricular tachycardia that occured even after chloroquine was discontinued. There was evidence of cardiac injury shown by increased serum level of troponin I. We propose a synergistic concept of lethal arrhythmia due to direct severe acute respiratory syndrome coronavirus (SARS-CoV)-2-associated cardiac injury, hyperinflammatory response, and drug-induced arrhythmia.</div></front></TEI><pubmed><MedlineCitation Status="PubMed-not-MEDLINE" Owner="NLM"><PMID Version="1">33402858</PMID><DateRevised><Year>2021</Year><Month>01</Month><Day>11</Day></DateRevised><Article PubModel="Electronic-eCollection"><Journal><ISSN IssnType="Print">1179-5476</ISSN><JournalIssue CitedMedium="Print"><Volume>13</Volume><PubDate><Year>2020</Year></PubDate></JournalIssue><Title>Clinical medicine insights. Case reports</Title><ISOAbbreviation>Clin Med Insights Case Rep</ISOAbbreviation></Journal><ArticleTitle>Lethal Arrhythmia (<i>Torsade de Pointes</i>) in COVID-19: An Event Synergistically Induced by Viral Associated Cardiac Injury, Hyperinflammatory Response, and Treatment Drug?</ArticleTitle><Pagination><MedlinePgn>1179547620972397</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1177/1179547620972397</ELocationID><Abstract><AbstractText>Arrhythmias in patients with coronavirus disease 2019 (COVID-19) are prevalent and deserve special attention because they are associated with an increased risk of fatal outcome. The mechanism of arrhythmia in COVID-19 remains unclear. Here, we report our first case of confirmed COVID-19 with documented Torsade de Pointes (TdP). A 64-year-old woman, previously healthy, presented to our emergency department with progressive shortness of breath, dry cough, and 1 week of fever. She was treated with chloroquine phosphate, meropenem, and ciprofloxacin. After 5 days of admission, her condition deteriorated and she was admitted to the intensive care unit. The patient had two episodes of malignant arrhythmias within 24 hours. The former was TdP, and the latter was a fatal pulseless ventricular tachycardia that occured even after chloroquine was discontinued. There was evidence of cardiac injury shown by increased serum level of troponin I. We propose a synergistic concept of lethal arrhythmia due to direct severe acute respiratory syndrome coronavirus (SARS-CoV)-2-associated cardiac injury, hyperinflammatory response, and drug-induced arrhythmia.</AbstractText><CopyrightInformation>© The Author(s) 2020.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Yasmin Kusumawardhani</LastName><ForeName>Nuraini</ForeName><Initials>N</Initials><AffiliationInfo><Affiliation>Department of Internal Medicine, Faculty of Medicine Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Huang</LastName><ForeName>Ian</ForeName><Initials>I</Initials><Identifier Source="ORCID">https://orcid.org/0000-0003-1189-8453</Identifier><AffiliationInfo><Affiliation>Department of Internal Medicine, Faculty of Medicine Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Martanto</LastName><ForeName>Erwan</ForeName><Initials>E</Initials><AffiliationInfo><Affiliation>Department of Internal Medicine, Faculty of Medicine Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Sihite</LastName><ForeName>Teddy Arnold</ForeName><Initials>TA</Initials><Identifier Source="ORCID">https://orcid.org/0000-0002-6259-8429</Identifier><AffiliationInfo><Affiliation>Department of Internal Medicine, Faculty of Medicine Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Nugraha</LastName><ForeName>Eka Surya</ForeName><Initials>ES</Initials><Identifier Source="ORCID">https://orcid.org/0000-0003-2961-6354</Identifier><AffiliationInfo><Affiliation>Department of Internal Medicine, Faculty of Medicine Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Prodjosoewojo</LastName><ForeName>Susantina</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Department of Internal Medicine, Faculty of Medicine Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Hamijoyo</LastName><ForeName>Laniyati</ForeName><Initials>L</Initials><Identifier Source="ORCID">https://orcid.org/0000-0002-1310-674X</Identifier><AffiliationInfo><Affiliation>Department of Internal Medicine, Faculty of Medicine Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Hartantri</LastName><ForeName>Yovita</ForeName><Initials>Y</Initials><Identifier Source="ORCID">https://orcid.org/0000-0002-1267-7815</Identifier><AffiliationInfo><Affiliation>Department of Internal Medicine, Faculty of Medicine Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D002363">Case Reports</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2020</Year><Month>12</Month><Day>14</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>Clin Med Insights Case Rep</MedlineTA><NlmUniqueID>101531893</NlmUniqueID><ISSNLinking>1179-5476</ISSNLinking></MedlineJournalInfo><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">COVID-19</Keyword><Keyword MajorTopicYN="N">arrhythmias</Keyword><Keyword MajorTopicYN="N">cardiac injury</Keyword><Keyword MajorTopicYN="N">chloroquine</Keyword><Keyword 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