open access

Vol 16, No 1 (2021)
Case report
Published online: 2021-02-27
Get Citation

New onset of ventricular arrhythmia in convalescent coronavirus disease 2019 patient

Maria Sawościan, Jagienka Szulc-Bagrowska, Inga Wójcik, Małgorzata Lelonek
DOI: 10.5603/FC.2021.0009
·
Folia Cardiologica 2021;16(1):64-70.

open access

Vol 16, No 1 (2021)
Case Reports
Published online: 2021-02-27

Abstract

Cardiac complications are counted among the complications of coronavirus disease 2019 (COVID-19) in hospitalized patients. However, the data of non-hospitalized COVID-19 convalescents’ population is scant. This study presents a case of a 42-year-old woman with no medical history who underwent SARS-CoV-2 (severe acute respiratory syndrome-related coronavirus 2) infection at 16 March 2020. She had a fever (38 degrees Celsius) and dyspnoea that resolved after chloroquine administration so the patient was not hospitalized. One week later she reported palpitations and fatigue of functional class II New York Heart Association despite negative repeated polymerase chain reaction results (23rd March, 1st April). Within 6 weeks she was referred to a cardiologist. The laboratory test results revealed slightly increased high-sensitivity cardiac troponin T and N-terminal pro-B-type natriuretic peptide. On electrocardiogram (ECG), single ventricular extrasystoles of right bundle branch block shape were observed. 24-hrs ECG Holter monitoring revealed additionally symptomatic periods of bigeminy and 4.2 thousands of ventricular extrasystoles. The cardiac magnetic resonance showed typical post-inflammatory myocardial changes with no active inflammation. No pharmacotherapy was applied. The symptoms have ceased. In the 4th month, 24-hrs ECG Holter revealed the recovery from arrhythmia. The presented case showed that long-term medical observation is worth to be considered even for non-hospitalized patients with a mild course of SARS-CoV-2 infection.

Abstract

Cardiac complications are counted among the complications of coronavirus disease 2019 (COVID-19) in hospitalized patients. However, the data of non-hospitalized COVID-19 convalescents’ population is scant. This study presents a case of a 42-year-old woman with no medical history who underwent SARS-CoV-2 (severe acute respiratory syndrome-related coronavirus 2) infection at 16 March 2020. She had a fever (38 degrees Celsius) and dyspnoea that resolved after chloroquine administration so the patient was not hospitalized. One week later she reported palpitations and fatigue of functional class II New York Heart Association despite negative repeated polymerase chain reaction results (23rd March, 1st April). Within 6 weeks she was referred to a cardiologist. The laboratory test results revealed slightly increased high-sensitivity cardiac troponin T and N-terminal pro-B-type natriuretic peptide. On electrocardiogram (ECG), single ventricular extrasystoles of right bundle branch block shape were observed. 24-hrs ECG Holter monitoring revealed additionally symptomatic periods of bigeminy and 4.2 thousands of ventricular extrasystoles. The cardiac magnetic resonance showed typical post-inflammatory myocardial changes with no active inflammation. No pharmacotherapy was applied. The symptoms have ceased. In the 4th month, 24-hrs ECG Holter revealed the recovery from arrhythmia. The presented case showed that long-term medical observation is worth to be considered even for non-hospitalized patients with a mild course of SARS-CoV-2 infection.
Get Citation

Keywords

SARS-CoV-2 infection, arrhythmia, myocarditis, non-hospitalized convalescent

About this article
Title

New onset of ventricular arrhythmia in convalescent coronavirus disease 2019 patient

Journal

Folia Cardiologica

Issue

Vol 16, No 1 (2021)

Article type

Case report

Pages

64-70

Published online

2021-02-27

DOI

10.5603/FC.2021.0009

Bibliographic record

Folia Cardiologica 2021;16(1):64-70.

Keywords

SARS-CoV-2 infection
arrhythmia
myocarditis
non-hospitalized convalescent

Authors

Maria Sawościan
Jagienka Szulc-Bagrowska
Inga Wójcik
Małgorzata Lelonek

References (25)
  1. Pirzada A, Mokhtar AT, Moeller AD. COVID-19 and myocarditis: what do we know so far? CJC Open. 2020; 2(4): 278–285.
  2. Inciardi RM, Lupi L, Zaccone G, et al. Cardiac involvement in a patient with coronavirus disease 2019 (COVID-19). JAMA Cardiol. 2020; 5(7): 819–824.
  3. Puntmann VO, Carerj ML, Wieters I, et al. Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from coronavirus disease 2019 (COVID-19). JAMA Cardiol. 2020; 5(11): 1265–1273.
  4. Kałużna-Oleksy M, Gackowski A, Jankowska EA, et al. The patient with heart failure in the face of the coronavirus disease 2019 pandemic: an expert opinion of the Heart Failure Working Group of the Polish Cardiac Society. Kardiol Pol. 2020; 78(6): 618–631.
  5. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020; 323(13): 1239–1242.
  6. Driggin E, Madhavan MV, Bikdeli B, et al. Cardiovascular considerations for patients, health care workers, and health systems during the COVID-19 pandemic. J Am Coll Cardiol. 2020; 75(18): 2352–2371.
  7. Pawlak A, Dreżewski K, Szymański P, et al. Cardiovascular disease, therapy, and mortality of oligosymptomatic and symptomatic patients infected with SARS-CoV-2: experiences of a designated hospital in Poland. Kardiol Pol. 2020; 78(11): 1162–1165.
  8. Ruan Q, Yang K, Wang W, et al. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med. 2020; 46(5): 846–848.
  9. Guzik TJ, Mohiddin SA, Dimarco A, et al. COVID-19 and the cardiovascular system: implications for risk assessment, diagnosis, and treatment options. Cardiovasc Res. 2020; 116(10): 1666–1687.
  10. Kunutsor SK, Laukkanen JA. Cardiovascular complications in COVID-19: a systematic review and meta-analysis. J Infect. 2020; 81(2): e139–e141.
  11. Shah S, Majmudar K, Stein A, et al. Novel use of home pulse oximetry monitoring in COVID-19 patients discharged from the emergency department identifies need for hospitalization. Acad Emerg Med. 2020; 27(8): 681–692.
  12. Alharthy A, Balhamar A, Faqihi F, et al. Insidious development of pulmonary embolism in asymptomatic patients with COVID-19: Two rare case-reports. Respir Med Case Rep. 2020; 31: 101186.
  13. Gervaise A, Bouzad C, Peroux E, et al. Acute pulmonary embolism in non-hospitalized COVID-19 patients referred to CTPA by emergency department. Eur Radiol. 2020; 30(11): 6170–6177.
  14. Huang Lu, Zhao P, Tang D, et al. Cardiac involvement in patients recovered from COVID-2019 identified using magnetic resonance imaging. JACC Cardiovasc Imaging. 2020; 13(11): 2330–2339.
  15. Gräni C, Eichhorn C, Bière L, et al. Prognostic value of cardiac magnetic resonance tissue characterization in risk stratifying patients with suspected myocarditis. J Am Coll Cardiol. 2017; 70(16): 1964–1976.
  16. Hu H, Ma F, Wei X, et al. Coronavirus fulminant myocarditis treated with glucocorticoid and human immunoglobulin. Eur Heart J. 2021; 42(2): 206.
  17. Paul JF, Charles P, Richaud C, et al. Myocarditis revealing COVID-19 infection in a young patient. Eur Heart J Cardiovasc Imaging. 2020; 21(7): 776.
  18. Irabien-Ortiz Á, Carreras-Mora J, Sionis A, et al. [Fulminant myocarditis due to COVID-19] [Article in English, Spanish]. Rev Esp Cardiol. 2020; 73(6): 503–504.
  19. Shi S, Qin Mu, Shen Bo, et al. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. JAMA Cardiol. 2020; 5(7): 802–810.
  20. Kociol RD, Cooper LT, Fang JC, et al. American Heart Association Heart Failure and Transplantation Committee of the Council on Clinical Cardiology. Recognition and initial management of fulminant myocarditis: a scientific statement from the American Heart Association. Circulation. 2020; 141(6): e69–e92.
  21. Siripanthong B, Nazarian S, Muser D, et al. Recognizing COVID-19-related myocarditis: the possible pathophysiology and proposed guideline for diagnosis and management. Heart Rhythm. 2020; 17(9): 1463–1471.
  22. In Vitro Studies Demonstrate Pfizer and BioNTech COVID-19 Vaccine Elicits Antibodies that Neutralize SARS-CoV-2 with Key Mutations Present in U.K. and South African Variants. https://www.pfizer.com/news/press-release/press-release-detail/vitro-studies-demonstrate-pfizer-and-biontech-covid-19 (February 18, 2021).
  23. Skipper CP, Pastick KA, Engen NW, et al. Hydroxychloroquine in nonhospitalized adults with early COVID-19: a randomized trial. Ann Intern Med. 2020; 173(8): 623–631.
  24. Mitjà O, Corbacho-Monné M, Ubals M, et al. BCN PEP-CoV-2 Research Group. Hydroxychloroquine for early treatment of adults with mild covid-19: a randomized-controlled trial. Clin Infect Dis. 2020 [Epub ahead of print].
  25. Hinton DM, chief scientist. Letter revoking EUA for chloroquine phosphate and hydroxychloroquine sulfate. Food and Drug Administration, Washington 2020. https://www.fda.gov/media/138945/download (December 10, 2020).

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

 

Wydawcą serwisu jest  "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl