Sudden Cardiac Death in COVID-19 patients, a Report of Three Cases

Shirazi, Samira; Mami, Sanaz; Mohtadi, Negar; Ghaysouri, Abas; Tabesh, Hamed; Nazari, Ali; Kokhazadeh, Taleb; Mollazadeh, Reza

doi:10.2217/fca-2020-0082

Cited by 46 publications

(46 citation statements)

References 15 publications

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“…One of the challenging issues in COVID-19 treatment is unwanted QT prolongation and risk of drug induced malignant arrhythmias, especially in the ICU patients with multiple comorbidities. [8,9]. Combining hydroxychloroquine with additional antiviral drugs such as lopinavir/ritonavir (which are both potent CYP3A4 inhibiting drugs) and azithromycin might result in higher plasma levels and a significant QT prolongation.…”

Section: Discussionmentioning

confidence: 99%

Electrocardiographic Holter monitoring findings in critical coronavirus disease-19 patients

Far¹,

Mehrakizadeh²,

Eslami³

et al. 2020

Polish Archives of Internal Medicine

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This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License (CC BY-NC-SA 4.0), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited, distributed under the same license, and used for noncommercial purposes only.

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Section: Discussionmentioning

confidence: 99%

Electrocardiographic Holter monitoring findings in critical coronavirus disease-19 patients

Far¹,

Mehrakizadeh²,

Eslami³

et al. 2020

Polish Archives of Internal Medicine

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“…Various forms of cardiac atrial and ventricular rhythm disorders have been reported in COVID-19 patients including atrial fibrillation, sinus tachycardia and bradycardia, complete conduction block and cardiac arrest [ 82 ]. Arrhythmia may associate with sudden cardiac death, which is a pathologic outcome also observed in COVID-19 patients [ [83] , [84] , [85] ]. Arrhythmia in COVID-19 patients is associated with myocardial injury and is thought to reflect the severity of illness [ 81 , 86 , 87 ].…”

Section: Sex Differences In Covid-19-related Cardiovascular Injurymentioning

confidence: 99%

Sex differences underlying preexisting cardiovascular disease and cardiovascular injury in COVID-19

Medzikovic¹,

Cunningham²,

Li³

et al. 2020

Journal of Molecular and Cellular Cardiology

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The novel 2019 coronavirus disease (COVID-19), resulting from severe acute respiratory syndrome coronarvirus-2 (SARS-CoV-2) infection, typically leads to respiratory failure in severe cases; however, cardiovascular injury is reported to contribute to a substantial proportion of COVID-19 deaths. Preexisting cardiovascular disease (CVD) is among the most common risk factors for hospitalization and death in COVID-19 patients, and the pathogenic mechanisms of COVID-19 disease progression itself may promote the development of cardiovascular injury, increasing risk of in-hospital death. Sex differences in COVID-19 are becoming more apparent as mounting data indicate that males seem to be disproportionately at risk of severe COVID-19 outcome due to preexisting CVD and COVID-19-related cardiovascular injury. In this review, we will provide a basic science perspective on current clinical observations in this rapidly evolving field and discuss the interplay sex differences, preexisting CVD and COVID-19-related cardiac injury.

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“…Infections by certain viruses like influenza and parvovirus B-19 are known to be some of the most common causes of myocarditis [ 46 , 47 ]. Autopsy reports of COVID patients show the presence of myocyte necrosis with lymphocytes in vicinity, suggestive of viral myocarditis [ 48 ].…”

Section: Cardiovascular Involvement In Covid-19 Patientsmentioning

confidence: 99%

“…A massive release of cytokines consequent to T-cell activation (IL-1, IL-10, IL-12, IL-6, IL-7, IFN-γ, TNF-α, CXCL10, CSF, etc.) may lead to direct myocardial fiber injury [ 9 – 11 , 29 , 41 , 46 , 51 , 52 ]. Cytokines such as TNF and IL-15 can directly induce myocardial fiber dysfunction, leading to stunning of the myocardium and poor contractile function [ 53 ].…”

Section: Cardiovascular Involvement In Covid-19 Patientsmentioning

confidence: 99%

“…One case of torsades de pointes was also reported Attributable risk unclear: Most had a pre-existing CVD. No control group Shirazi et al [ 46 ] (2020, Case series) 3 patients given HCQ along with lopinavir/ritonavir and other regimens Sudden cardiac death in all three patients. (It is suggested that the cardiac arrest was due to the proarrythmatic effects of HCQ which along with liponavir/ritonavir could have led to QTc prolongation and development of TdP) ECG of patients prior to death was not available to confirm the hypothesis.…”

Section: Cardiovascular Involvement In Covid-19 Patientsmentioning

confidence: 99%

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COVID-19, hydroxychloroquine and sudden cardiac death: implications for clinical practice in patients with rheumatic diseases

et al. 2021

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Sudden cardiac death is commonly seen due to arrhythmias, which is a common cardiac manifestation seen in COVID-19 patients, especially those with underlying cardiovascular disease (CVD). Administration of hydroxychloroquine (HCQ) as a potential treatment option during SARS-CoV-2, initially gained popularity, but later, its safe usage became questionable due to its cardiovascular safety, largely stemming from instances of cardiac arrhythmias in COVID-19. Moreover, in the setting of rheumatic diseases, in which patients are usually on HCQ for their primary disease, there is a need to scale the merits and demerits of HCQ usage for the treatment of COVID-19. In this narrative review, we aim to address the association between usage of HCQ and sudden cardiac death in COVID-19 patients. MEDLINE, EMBASE, ClinicalTrials.gov and SCOPUS databases were used to review articles in English ranging from case reports, case series, letter to editors, systematic reviews, narrative reviews, observational studies and randomized control trials. HCQ is a potential cause of sudden cardiac death in COVID-19 patients. As opposed to the reduction in CVD with HCQ in treatment of systemic lupus erythematous, rheumatoid arthritis, and other rheumatic diseases, safe usage of HCQ in COVID-19 patients is unclear; whereby, it is observed to result in QTc prolongation and Torsades de pointes even in patients with no underlying cardiovascular comorbidity. This is occasionally associated with sudden cardiac death or cardiac arrest; hence, its clinical efficacy needs further investigation by large-scale clinical trials.

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Sudden Cardiac Death in COVID-19 patients, a Report of Three Cases

Cited by 46 publications

References 15 publications

Electrocardiographic Holter monitoring findings in critical coronavirus disease-19 patients

Electrocardiographic Holter monitoring findings in critical coronavirus disease-19 patients

Sex differences underlying preexisting cardiovascular disease and cardiovascular injury in COVID-19

COVID-19, hydroxychloroquine and sudden cardiac death: implications for clinical practice in patients with rheumatic diseases

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