A COVID-19 Patient Presenting With Paroxysmal Atrial Fibrillation

Abstract

The cardiovascular system is influenced in the course of coronavirus disease 2019 (COVID-19); paroxysmal atrial fibrillation (PAF) is not uncommon in hospitalized patients with COVID-19. This is a report of an atypical presentation of a 78-year-old patient who was diagnosed with COVID-19 infection. The patient, in the acute setting, was diagnosed with rapidly deteriorating cardiac failure associated with PAF, respiratory distress, and deteriorating vitals, and was eventually intubated. The mechanisms and preexisting substrates of atrial fibrillation in COVID-19 patients are discussed. A connection between arrhythmia and COVID-19, on the basis of a generalized inflammatory state, is suggested. This particular case adds to the understanding that the occurrence of PAF in COVID-19 patients is consistent with the mechanism of worse outcomes due to systemic inflammation.

COVID-19 HEART unveiling as atrial fibrillation: pathophysiology, management and future directions for research

“…Severe myocarditis Intravenous diuretics, rate control agents, anticoagulation, ACE inhibitor and mineralocorticoid Clinical recovery. Cardiac MRI at 3-month interval planned with outpatient follow-up [ 55 ] 8 78-year-old Caucasian male Altered mental status, panic attack, palpitations, nausea, numbness, tachypnea, heavy breathing, dry cough and chest discomfort BP 137/71 O2 sat 83% Temp 39.7C HR ~ 115 RR ~ 33 Irregular rhythm Bibasilar crackles Pulse deficit EKG AF with RVR Anion gap : abnormal Metabolic alkalosis Echo: borderline abnormal LVEF (50–55%), LV diastolic dysfunction, mild pericardial effusion, moderate septal hypertrophy, mild dilated LV (LVEDD: 58.9 mm and LVESD: 40.7 mm) and restrictive LV filling pattern ICU admission, intubation, vasopressor, supportive care, dexamethasone, hydroxychloroquine, remdesevir, IV Ibutilide, anticoagulation and azithromycin Normal sinus rhythm was restored two days prior to extubation [ 56 ] 9 72-year-old male Severely hypoxic patient (Sp02 65%) Irregular heart rhythm, exhausted, perspiring, bilateral medium crackles, EKG: AF Echo : Globally reduced LV systolic function, EF 30% Intubation, Non-adrenaline, Dobutamine, Volume resuscitation, Argipressin, Dexamethasone, Landiolol, amiodarone, digitoxin, ivabradine and Levosimandan Pericardial tamponade Cardiogenic shock Death [ 57 ] 10 18 y male Refractory hypotension, blurry vision, eye redness, nausea, vomiting, cheat pain, nausea, vomiting, syncope, dizziness and refractory hypotension BP 80/40 HR ~ 120 Hepatomegaly Injected conjunctiva Erythematous tongue Blanching rash on palm and wrists EKG: AF, wide complex tachycardia Echo : mild pericardial effusion Cardioversion 100–150 J Bolus of Amiodarone Low dose epinephrine Normal sinus rhythm is restored with complete clinical recovery [ 58 ] …”

Fear of COVID-19 Among Elderly Patients with a Chronic Physical or Mental Disease

“…Likewise, although cardiovascular comorbidity in COVID-19 patients increases mortality, similar fears kept heart disease patients away from seeking urgent health care, despite having symptoms (Nouskas et al, 2021). In fact, the number of patients with heart attack who were admitted for urgent care has dropped by more than 50% during the COVID-19 outbreak, according to an extensive worldwide survey by the European Society of Cardiology (Pessoa-Amorim et al, 2020).…”