Temporary sinus bradycardia and COVID-19. Report of a case and review of the bibliography

Abstract

A cytokine storm, probably due to an imbalance in T-cell activation, could contribute to cardiovascular disease in COVID-19. Cohort studies estimated that 7-80% of hospitalized patients presented acute myocardial injury, with a greater expression in patients admitted to the intensive care unit vs. those who did not (22.2% vs. 2.0%), and in those who died vs. survivors (59% vs 1%). The first reports from China suggested an incidence of arrhythmias in hospitalized patients of 17%, rising in critical care to 44%. We present the case of a patient with a positive swab for SARS-CoV-2 infection with an interstitial-alveolar parenchymal infiltrate distributed in a generalized way in both lung fields, who required respiratory mechanical assistance. On the fourth day of hospitalization, he developed sinus bradycardia, requiring treatment with atropine and infusion of isoproterenol, resolving the clinical picture after 24 hours. The causal mechanism of sinus bradycardia is not exactly known, it is believed that it could be multifactorial, including severe hypoxia, hypotension, intrinsic imbalances of the autonomic nervous system, alteration in the regulation of the angiotensin converting enzyme 2, drug interactions and immune-inflammatory direct damage on the sinus node.