Novel COVID-19 associated sinus node dysfunction: A case ser
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This report presents two cases of new-onset SND in patients recently diagnosed with COVID-19. Patient 1 is a 70-year-old female with no major past medical history who was intubated for acute hypoxic respiratory failure secondary to COVID-19 pneumonia and developed new-onset sinus bradycardia without a compensatory increase in heart rate in response to relative hypotension. Patient 2 is an 81-year-old male with a past medical history of an ascending aortic aneurysm, hypertension, and obstructive sleep apnoea who required intubation for COVID-19-induced acute hypoxic respiratory failure and exhibited new-onset sinus bradycardia followed by numerous episodes of haemodynamically significant accelerated idioventricular rhythm. Two weeks following the onset of SND, both patients remain in sinus bradycardia.

COVID-19-associated SND has not previously been described. The potential mechanisms for SND in patients with COVID-19 include myocardial inflammation or direct viral infiltration. Patients diagnosed with COVID-19 should be monitored closely for the development of bradyarrhythmia and haemodynamic instability.

Learning points:
1. Novel coronavirus disease-19 (COVID-19) may cause pathological sinus node dysfunction in affected patients.

2. The mechanism for COVID-19-induced sinus node dysfunction is likely to be secondary to cardiac inflammation or direct viral infiltration.

3. Patients with COVID-19 should be monitored closely for development of bradyarrhythmia and haemodynamic instability.

Source: https://academic.oup.com/ehjcr/advance-article/doi/10.1093/ehjcr/ytaa132/5834520
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