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Abstract

The burden of Coronavirus Disease 2019 (COVID-19) has been identified as causing multiorgan damage. Respiratory compromise remains one of the most common presentations, but cardiac injuries, including myocardial injury, ischemia, and conduction abnormalities, are also becoming prevalent. We present a case of an 87-year-old male with a history of dementia, type 2 diabetes mellitus, hypertension, chronic kidney disease, and a left kidney transplant. He was hospitalized for respiratory distress and generalized tonic-clonic seizures. Upon admission, he was found to be bradycardic, with a heart rate of 27 beats per minute, and hypotensive, with a mean arterial pressure below 60 mmHg. An electrocardiogram (EKG) depicted high-grade atrioventricular block (AV block). A transvenous pacemaker was placed via femoral access, and he tested positive for COVID-19. A workup was conducted to rule out possible causes of bradycardia, such as hypothyroidism, ischemia, AV nodal blocking agents, and drug-induced bradycardia, but results were negative. His hospital stay was complicated by methicillin-resistant Staphylococcus aureus (MRSA) pneumonia, leading to empyema and bacteremia. Unfortunately, due to his critical condition, the family opted for comfort measures, and he died. Our clinical vignette highlights that cardiovascular complications in COVID-19 patients are associated with poor outcomes if not addressed. Conduction abnormalities in patients with normal cardiac structure and function are becoming more common in the setting of COVID infection. Assessment with serial EKGs and cardiac monitoring might be essential, as patients can develop AV blocks at any point in the course of the disease.

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