Incomplete Trifascicular Block and Mobitz Type II Atrioventricular Block in COVID-19.
Identifieur interne : 000982 ( Main/Corpus ); précédent : 000981; suivant : 000983Incomplete Trifascicular Block and Mobitz Type II Atrioventricular Block in COVID-19.
Auteurs : James C. Gubitosa ; Phoenix Xu ; Ahmed Ahmed ; Kathleen PergamentSource :
- Cureus [ 2168-8184 ] ; 2020.
Abstract
A 74-year-old female with a history of diabetes presented with chest pain and shortness of breath for two days. She was hypoxic to an oxygen saturation of 60% in the emergency department, requiring bilevel positive airway pressure (BiPAP) to maintain saturations. Chest X-ray demonstrated bilateral hazy opacities suspicious for viral pneumonia. Coronavirus disease 2019 (COVID-19) was confirmed. Right bundle branch block (RBBB) with left anterior fascicular block was noted on admission electrocardiogram (ECG). Cardiac enzymes and brain natriuretic peptide levels were within normal limits. After noting frequent pauses on telemetry, a repeat ECG was performed that demonstrated RBBB with left posterior fascicular block as well as second-degree atrioventricular block (Mobitz type II). Transcutaneous pacing pads were placed, and atropine was placed at the bedside. Cardiac enzymes remained negative. Interleukin-6 levels were elevated at 159 pg/mL. Hydroxychloroquine was deferred due to the patient's arrhythmia and prolonged QTc. Tocilizumab was deferred due to the patient's age. The patient's oxygen requirements and mental status continued to worsen. She continued to desaturate despite maximal BiPAP therapy and eventually died. Cardiac involvement in COVID-19, whether caused primarily by the virus, secondary to its clinical sequelae, or even due to its treatment, cannot be ignored. Further high-quality research is needed to clarify the cardiac pathophysiology. Thorough cardiac exams with electrocardiographic correlation should be performed on all patients with COVID-19. Clinicians should not hesitate to consult cardiovascular services in the event of abnormality.
DOI: 10.7759/cureus.10461
PubMed: 33083164
PubMed Central: PMC7566987
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Gubitosa</name><affiliation><nlm:affiliation>Internal Medicine, University Hospital - Rutgers New Jersey Medical School, Newark, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Xu, Phoenix" sort="Xu, Phoenix" uniqKey="Xu P" first="Phoenix" last="Xu">Phoenix Xu</name><affiliation><nlm:affiliation>Internal Medicine, University Hospital - Rutgers New Jersey Medical School, Newark, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Ahmed, Ahmed" sort="Ahmed, Ahmed" uniqKey="Ahmed A" first="Ahmed" last="Ahmed">Ahmed Ahmed</name><affiliation><nlm:affiliation>Internal Medicine, University Hospital - Rutgers New Jersey Medical School, Newark, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Pergament, Kathleen" sort="Pergament, Kathleen" uniqKey="Pergament K" first="Kathleen" last="Pergament">Kathleen Pergament</name><affiliation><nlm:affiliation>Internal Medicine, University Hospital - Rutgers New Jersey Medical School, Newark, USA.</nlm:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2020">2020</date><idno type="RBID">pubmed:33083164</idno><idno type="pmid">33083164</idno><idno type="doi">10.7759/cureus.10461</idno><idno type="pmc">PMC7566987</idno><idno type="wicri:Area/Main/Corpus">000982</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000982</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Incomplete Trifascicular Block and Mobitz Type II Atrioventricular Block in COVID-19.</title><author><name sortKey="Gubitosa, James C" sort="Gubitosa, James C" uniqKey="Gubitosa J" first="James C" last="Gubitosa">James C. Gubitosa</name><affiliation><nlm:affiliation>Internal Medicine, University Hospital - Rutgers New Jersey Medical School, Newark, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Xu, Phoenix" sort="Xu, Phoenix" uniqKey="Xu P" first="Phoenix" last="Xu">Phoenix Xu</name><affiliation><nlm:affiliation>Internal Medicine, University Hospital - Rutgers New Jersey Medical School, Newark, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Ahmed, Ahmed" sort="Ahmed, Ahmed" uniqKey="Ahmed A" first="Ahmed" last="Ahmed">Ahmed Ahmed</name><affiliation><nlm:affiliation>Internal Medicine, University Hospital - Rutgers New Jersey Medical School, Newark, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Pergament, Kathleen" sort="Pergament, Kathleen" uniqKey="Pergament K" first="Kathleen" last="Pergament">Kathleen Pergament</name><affiliation><nlm:affiliation>Internal Medicine, University Hospital - Rutgers New Jersey Medical School, Newark, USA.</nlm:affiliation></affiliation></author></analytic><series><title level="j">Cureus</title><idno type="ISSN">2168-8184</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">A 74-year-old female with a history of diabetes presented with chest pain and shortness of breath for two days. She was hypoxic to an oxygen saturation of 60% in the emergency department, requiring bilevel positive airway pressure (BiPAP) to maintain saturations. Chest X-ray demonstrated bilateral hazy opacities suspicious for viral pneumonia. Coronavirus disease 2019 (COVID-19) was confirmed. Right bundle branch block (RBBB) with left anterior fascicular block was noted on admission electrocardiogram (ECG). Cardiac enzymes and brain natriuretic peptide levels were within normal limits. After noting frequent pauses on telemetry, a repeat ECG was performed that demonstrated RBBB with left posterior fascicular block as well as second-degree atrioventricular block (Mobitz type II). Transcutaneous pacing pads were placed, and atropine was placed at the bedside. Cardiac enzymes remained negative. Interleukin-6 levels were elevated at 159 pg/mL. Hydroxychloroquine was deferred due to the patient's arrhythmia and prolonged QTc. Tocilizumab was deferred due to the patient's age. The patient's oxygen requirements and mental status continued to worsen. She continued to desaturate despite maximal BiPAP therapy and eventually died. Cardiac involvement in COVID-19, whether caused primarily by the virus, secondary to its clinical sequelae, or even due to its treatment, cannot be ignored. Further high-quality research is needed to clarify the cardiac pathophysiology. Thorough cardiac exams with electrocardiographic correlation should be performed on all patients with COVID-19. Clinicians should not hesitate to consult cardiovascular services in the event of abnormality.</div></front></TEI><pubmed><MedlineCitation Status="PubMed-not-MEDLINE" Owner="NLM"><PMID Version="1">33083164</PMID><DateRevised><Year>2020</Year><Month>10</Month><Day>22</Day></DateRevised><Article PubModel="Electronic"><Journal><ISSN IssnType="Print">2168-8184</ISSN><JournalIssue CitedMedium="Print"><Volume>12</Volume><Issue>9</Issue><PubDate><Year>2020</Year><Month>Sep</Month><Day>15</Day></PubDate></JournalIssue><Title>Cureus</Title><ISOAbbreviation>Cureus</ISOAbbreviation></Journal><ArticleTitle>Incomplete Trifascicular Block and Mobitz Type II Atrioventricular Block in COVID-19.</ArticleTitle><Pagination><MedlinePgn>e10461</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.7759/cureus.10461</ELocationID><Abstract><AbstractText>A 74-year-old female with a history of diabetes presented with chest pain and shortness of breath for two days. She was hypoxic to an oxygen saturation of 60% in the emergency department, requiring bilevel positive airway pressure (BiPAP) to maintain saturations. Chest X-ray demonstrated bilateral hazy opacities suspicious for viral pneumonia. Coronavirus disease 2019 (COVID-19) was confirmed. Right bundle branch block (RBBB) with left anterior fascicular block was noted on admission electrocardiogram (ECG). Cardiac enzymes and brain natriuretic peptide levels were within normal limits. After noting frequent pauses on telemetry, a repeat ECG was performed that demonstrated RBBB with left posterior fascicular block as well as second-degree atrioventricular block (Mobitz type II). Transcutaneous pacing pads were placed, and atropine was placed at the bedside. Cardiac enzymes remained negative. Interleukin-6 levels were elevated at 159 pg/mL. Hydroxychloroquine was deferred due to the patient's arrhythmia and prolonged QTc. Tocilizumab was deferred due to the patient's age. The patient's oxygen requirements and mental status continued to worsen. She continued to desaturate despite maximal BiPAP therapy and eventually died. Cardiac involvement in COVID-19, whether caused primarily by the virus, secondary to its clinical sequelae, or even due to its treatment, cannot be ignored. Further high-quality research is needed to clarify the cardiac pathophysiology. Thorough cardiac exams with electrocardiographic correlation should be performed on all patients with COVID-19. Clinicians should not hesitate to consult cardiovascular services in the event of abnormality.</AbstractText><CopyrightInformation>Copyright © 2020, Gubitosa et al.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Gubitosa</LastName><ForeName>James C</ForeName><Initials>JC</Initials><AffiliationInfo><Affiliation>Internal Medicine, University Hospital - Rutgers New Jersey Medical School, Newark, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Xu</LastName><ForeName>Phoenix</ForeName><Initials>P</Initials><AffiliationInfo><Affiliation>Internal Medicine, University Hospital - Rutgers New Jersey Medical School, Newark, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ahmed</LastName><ForeName>Ahmed</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Internal Medicine, University Hospital - Rutgers New Jersey Medical School, Newark, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Pergament</LastName><ForeName>Kathleen</ForeName><Initials>K</Initials><AffiliationInfo><Affiliation>Internal Medicine, University Hospital - Rutgers New Jersey Medical School, Newark, USA.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D002363">Case Reports</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2020</Year><Month>09</Month><Day>15</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>Cureus</MedlineTA><NlmUniqueID>101596737</NlmUniqueID><ISSNLinking>2168-8184</ISSNLinking></MedlineJournalInfo><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">bifascicular block</Keyword><Keyword MajorTopicYN="N">clinical cardiac electrophysiology</Keyword><Keyword MajorTopicYN="N">clinical cardiology</Keyword><Keyword MajorTopicYN="N">covid 19</Keyword><Keyword MajorTopicYN="N">covid-19 pneumonia</Keyword><Keyword MajorTopicYN="N">electrocardiogram (ecg/ekg)</Keyword><Keyword MajorTopicYN="N">mobitz type 2 av block</Keyword><Keyword MajorTopicYN="N">qtc prolongation</Keyword><Keyword MajorTopicYN="N">second-degree heart block</Keyword><Keyword MajorTopicYN="N">trifascicular block</Keyword></KeywordList><CoiStatement>The authors have declared that no competing interests exist.</CoiStatement></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="entrez"><Year>2020</Year><Month>10</Month><Day>21</Day><Hour>6</Hour><Minute>3</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2020</Year><Month>10</Month><Day>22</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2020</Year><Month>10</Month><Day>22</Day><Hour>6</Hour><Minute>1</Minute></PubMedPubDate></History><PublicationStatus>epublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">33083164</ArticleId><ArticleId IdType="doi">10.7759/cureus.10461</ArticleId><ArticleId IdType="pmc">PMC7566987</ArticleId></ArticleIdList><ReferenceList><Reference><Citation>JAMA. 2020 Mar 17;323(11):1061-1069</Citation><ArticleIdList><ArticleId IdType="pubmed">32031570</ArticleId></ArticleIdList></Reference><Reference><Citation>Lancet. 2020 Mar 28;395(10229):1054-1062</Citation><ArticleIdList><ArticleId IdType="pubmed">32171076</ArticleId></ArticleIdList></Reference><Reference><Citation>JACC Clin Electrophysiol. 2015 Dec;1(6):529-538</Citation><ArticleIdList><ArticleId IdType="pubmed">29759406</ArticleId></ArticleIdList></Reference><Reference><Citation>J Infect Dis. 1992 Jan;165(1):134-40</Citation><ArticleIdList><ArticleId IdType="pubmed">1309370</ArticleId></ArticleIdList></Reference><Reference><Citation>J Am Coll Cardiol. 2019 Aug 20;74(7):932-987</Citation><ArticleIdList><ArticleId IdType="pubmed">30412710</ArticleId></ArticleIdList></Reference><Reference><Citation>Eur Heart J. 2020 May 14;41(19):1859</Citation><ArticleIdList><ArticleId IdType="pubmed">32282027</ArticleId></ArticleIdList></Reference><Reference><Citation>Infection. 2020 Oct;48(5):773-777</Citation><ArticleIdList><ArticleId IdType="pubmed">32277408</ArticleId></ArticleIdList></Reference><Reference><Citation>Lancet Respir Med. 2020 Apr;8(4):420-422</Citation><ArticleIdList><ArticleId IdType="pubmed">32085846</ArticleId></ArticleIdList></Reference><Reference><Citation>J Cardiovasc Electrophysiol. 2020 May;31(5):1003-1008</Citation><ArticleIdList><ArticleId IdType="pubmed">32270559</ArticleId></ArticleIdList></Reference><Reference><Citation>Int J Cardiol. 2020 Jul 15;311:116-121</Citation><ArticleIdList><ArticleId IdType="pubmed">32291207</ArticleId></ArticleIdList></Reference><Reference><Citation>Lancet Infect Dis. 2020 May;20(5):533-534</Citation><ArticleIdList><ArticleId IdType="pubmed">32087114</ArticleId></ArticleIdList></Reference></ReferenceList></PubmedData></pubmed></record>Pour manipuler ce document sous Unix (Dilib)
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