Introduction
On December 31, 2019, several cases of pneumonia-like illness were
attributed to a seafood wholesale market in the Wuhan province of China
(1). On January 7, 2020, the public health officials in China confirmed
that these cases were caused by the novel severe acute respiratory
distress syndrome coronavirus 2, SARS-CoV-2, also referred to as
COVID-19 (2). Recent epidemiologic data has indicated coronavirus to be
highly contagious with high risk of person-to-person transmission (3,4).
On March 11, 2020, the World Health Organization (WHO) declared COVID-19
a pandemic. As of April 9, 2020, there have been a total of 1,587,209
cases and 95,455 deaths reported in at least 209 countries (5). As of
April 9, 2020, 456,828 of these cases and 16,548 of these deaths have
been reported in the United States (5).
Age, male sex, and comorbidity seem to be risk factors for poor outcomes
in COVID-19 patients. Despite a low overall case fatality rate of 2.3%,
mortality rates among COVID-19 cases are higher among elderly (14.8% in
patients over 80 years) and among patients with cardiovascular disease,
hypertension, and diabetes (10.5%, 6.0%, and 7.3%, respectively) (6).
Earlier study suggested the most common symptoms associated with
COVID-19 are fever (88%) and dry cough (67.7%). Less common symptoms
include rhinorrhea (4.8%) and gastrointestinal symptoms such as
diarrhea (4-14%) and nausea (5%)(7). 14% of patients experienced
severe symptoms such as shortness of breath, hypoxia, and respiratory
distress. 5% of patients were critical requiring mechanical ventilation
in an intensive care unit with clinical presentation of respiratory
failure, septic shock, and/or multiorgan failure (8).
Radiological investigations including chest x-ray and CT scan of chest
are characterized by findings of bilateral ground glass interstitial
infiltrates indicative of atypical pneumonia. Laboratory workup often
shows leukopenia and thrombocytopenia. There can be associated
transaminitis as well as elevated ESR, ferritin, LDH, and d-dimer.
Complications include acute respiratory distress syndrome (ARDS), acute
cardiac injury, and secondary infections (9).
With the increasing number of confirmed cases and the accumulating
clinical data, the cardiac manifestations induced by COVID-19 have
generated great concern. Recent study of 138 patients hospitalized with
COVID-19 infection showed 16.7% and 7.2% patients later developing
arrhythmia and acute cardiac injury, respectively (10). In a separate
study 12.5% of patients with COVID-19 were diagnosed with acute
myocardial infarction, manifested with elevated cardiac enzymes (9).
COVID-19 was also associated with cardiac arrest, acute-onset heart
failure, and myocarditis. COVID-19 has not been reported as the cause of
abnormalities of cardiac conduction system. We present a case report
that describes presence of high-grade atrioventricular (AV block)
requiring pacemaker support in a patient affected by COVID-19.