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Atrial fibrillation: a risk factor for unfavourable outcome in COVID-19? A case report

Sebastian Schnaubelt1, Marie-Kathrin Breyer2, Jolanta Siller-Matula3,4

  • 1Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.

European Heart Journal. Case Reports
|October 22, 2020
PubMed

Insights

COVID-19 can cause severe heart problems, especially in older adults with atrial fibrillation. Managing heart failure in these patients requires controlling heart rate and rhythm, and possibly immunomodulation.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • COVID-19 is associated with cardiac complications like myocarditis, arrhythmias, and pericardial tamponade.
  • Atrial fibrillation is prevalent in elderly individuals, a demographic highly susceptible to severe COVID-19 outcomes.
  • Understanding the interplay between COVID-19 and pre-existing cardiac conditions is crucial.

Observation:

  • A 72-year-old male with SARS-CoV-2 presented with delirium and acute respiratory failure.
  • His pre-existing atrial fibrillation worsened, necessitating complex rate and rhythm management.
  • The patient developed progressive heart failure, hemodynamic instability, acute kidney injury, and pericardial tamponade.

Findings:

  • Fulminant cardiac involvement in COVID-19 can be exacerbated by pre-existing conditions such as atrial fibrillation.
  • The cytokine storm in severe COVID-19 can precipitate hemodynamic deterioration and multi-organ dysfunction.
  • Pericardial tamponade is a critical complication that can arise in severe COVID-19 with cardiac compromise.

Implications:

  • Effective management of COVID-19 cardiac complications requires addressing both the viral infection and underlying cardiac conditions.
  • Rate or rhythm control is essential for managing tachycardic atrial fibrillation in critically ill COVID-19 patients.
  • Immunomodulatory therapies may play a role in mitigating the cytokine storm and improving outcomes in severe COVID-19 with cardiac involvement.
Abstract

Keywords:
Atrial fibrillationCOVID-19Cardiac tamponadeCase reportMultiorgan failure

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