Background:
Complete heart block is commonly due to ischemia, cardiomyopathy, myocarditis, endocarditis, idiopathic or iatrogenic causes. Common signs of heart block include fatigue, chest pain, dyspnea, presyncope and syncope. With myocarditis, the most common cause is usually a viral infection with organisms such as adenovirus and enteroviruses. Symptoms of myocarditis vary depending on chronicity. There is some degree of sclerosis and fibrosis of the conduction system which can cause complete heart block, especially in the elderly.
Case:
A 59 year old female with past medical history of hypertension and COVID in December of 2020 presents with recurrent episodes of near syncope. Episodes consisted of a sensation in her ears followed by tunnel vision, a feeling of warmth and shortness of breath. The episodes last several seconds at a time and occur in any position at rest or with activity. When the patient had COVID, they did not require hospitalization for management of their symptoms. She has since received the COVID vaccines in April of 2021.
Decision-making:
Echocardiogram showed normal ejection fraction with no regional wall motion or structural abnormalities. Event monitor showed recurrent pauses due to paroxysmal heart block with the longest episode being 7.2 seconds. Baseline electrocardiogram demonstrated an incomplete right bundle branch block. Thyroid stimulating hormone levels were normal. Detailed clinical history showed no suspicion for Lyme disease. Patient was seen and evaluated by electrophysiology and is planned for dual-chamber pacemaker placement.
Conclusion:
In our case, the underlying etiology of the paroxysmal heart block in this patient is most likely due to the recent COVID infection given that no other etiology was found. There are some reports of myocarditis associated with the COVID vaccine as well. But there are very few, if any, reports of complete heart block as a sequelae of the infection. Most of the case reports are in patients with active COVID infection with very few, if any reports of post infection sequelae. This is an important manifestation of the COVID virus infection which must be considered in the differential diagnosis of complete heart block.
Footnotes
Poster Contributions
For exact presentation time, refer to the online ACC.22 Program Planner at https://www.abstractsonline.com/pp8/#!/10461
Session Title: Complex Clinical Cases: FIT Flatboard Poster Selections – Covid
Abstract Category: FIT: Coronavirus Disease (COVID-19)