Sinus bradycardia in hospitalized patients with COVID-19: a case series

Abstract

Although COVID-19 primarily affects the lungs, it also involves the cardiovascular system. Sinus bradycardia is a rare manifestation during acute infection and has been infrequently reported among patients with COVID-19 in our country. Therefore, the objective of this study is to describe the epidemiological, clinical, electrocardiographic, laboratory blood analysis and tomographic characteristics, as well as the treatment and progress of patients hospitalized due to SARS-CoV-2 pneumonia—without cardiovascular comorbidities—who developed sinus bradycardia. A descriptive case series study was conducted involving adults with a heart rate of less than 60 beats per minute, upon admission or during hospitalization, as documented by electrocardiogram, and who were referred to the cardiology department for this reason. Patients with a prior diagnosis of cardiovascular diseases (other than systemic arterial hypertension), those medicated with bradycardic or inotropic agents during the bradycardia event or those with atrioventricular blocks were excluded. The sample consisted of 18 patients. The age was 54.5 years, 61.11 % of the patients were male, and the most common comorbidity was systemic arterial hypertension. The duration of illness was 10 days, the time from the onset of symptoms to bradycardia was 11.5 days, and the heart rate during bradycardia was 45.5 beats per minute. Furthermore, 55.56 % of the patients had a heart rate of 40 to 49 beats per minute. The PaO2/FiO2 ratio, total severity tomographic score, lactate and potassium values at admission were 169.6, 13 points, 1.7 mmol/L and 3.8 mEq/L, respectively. During bradycardia, the PaO2/FiO2, lactate and potassium values were 204.5, 1.9 mmol/L and 3.9 mEq/L, respectively. No patient presented with hypotension, and three died. Sinus bradycardia was moderate and transient in most patients, occurring after the first week of illness and resolving spontaneously.