Complete AV Block in Vaccinated COVID-19 Patient

 An 84-year-old male with a history of coronary artery disease, hypertension, and hyperlipidemia presented to an urgent care in with body aches, malaise, fatigue, and dyspnea for three days - six months after receiving second doze of Pfizer vaccine. No other infectious symptoms were endorsed. He denied any symptoms of lightheadedness, dizziness, palpitations, orthopnea, and chest pain.At the outside facility, he was found to be bradycardic with a complete AV block. Total of atropine 1.0 mg was administered at that encounter. Afterwards, the patient went into a supraventricular tachycardia briefly with spontaneous return to a complete AV block. He was placed on transcutaneous pacing. His previously known heart rate ranged between 77 and 99 and a visit to his cardiologist a week prior reveled no abnormalities. Prior PR interval was 128. He had no history of tobacco, alcohol, or drug use. A possible culprit home medication was atenolol 50 mg daily which he reported taking as instructed. No other pertinent or new medications were noted in the patient’s history.


Underlying EKG without pacing showed an atrial rate of 128 bpm and a ventricular rate of 48 bpm. Chest X-ray on admission showed pulmonary infiltrates without cardiomegaly

The patient was started on a low-dose dopamine infusion at 10 mcg/kg/min and dexamethasone 6 mg IV QD. Infectious disease team was consulted, and remdesivir was started based on a multidisciplinary team approach. Blood pressure remained between 140/76 and 162/62. The patient remained awake and comfortable. The patient was offered both cardiac catheterization and permanent pacemaker placement; however, after an extensive discussion with the patient and his son, the patient refused all invasive therapeutic intervention. The patient was discontinued off the dopamine infusion as well as transcutaneous pacing; however, he was continued on methylprednisolone and remdesivir. On posthospitalization day 6, his symptoms at onset had grossly improved, and given his aversion to testing, no follow-up imaging was conducted. He was discharged safely still in AV block with home oxygen.

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REFERENCE

Lee K, Rahimi O, Gupta N, Ahsan C. Complete AV Block in Vaccinated COVID-19 Patient. Case Reports in Cardiology. 2022 Mar 30;2022.

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