SHM Converge Scientific Abstract ePoster Gallery-A Rare Case of Sinus Pause in a Covid-19 Patient

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This case describes a 71-year-old man with schizophrenia who presented with fever, shortness of breath, and altered mental status and was found to have COVID-19 pneumonia with hypoxia. His workup showed thrombocytopenia and lymphopenia, but thyroid studies, electrolytes, head CT, EEG, and toxicology testing were unremarkable. He was started on dexamethasone and remdesivir for COVID-19.<br /><br />Approximately 10 hours after receiving the remdesivir loading dose, his heart rate dropped into the 50s and he developed a 5.19-second sinus pause. He remained asymptomatic and hemodynamically stable. Repeat ECG showed normal sinus rhythm with a normal QTc. He had no prior history of cardiovascular disease, chronic bradycardia, or use of nodal-blocking medications. After cardiology evaluation and a negative workup for other causes, remdesivir was considered the likely cause, and it was discontinued. He later had one brief additional asymptomatic sinus pause of less than 2 seconds, but no further episodes occurred. His heart rate stayed above 60 beats per minute with normal repeat ECGs for the rest of his hospitalization.<br /><br />The authors discuss possible mechanisms for remdesivir-associated bradycardia or sinus pause, including mitochondrial toxicity, adenosine-like effects on sinus node automaticity, and effects on AV nodal conduction. They recommend obtaining a baseline ECG before starting remdesivir and closely monitoring patients on telemetry, especially those taking other medications that can slow heart rate. They emphasize that remdesivir should be stopped if bradycardia or sinus pause develops after other reversible causes are excluded.

Asset Subtitle

Umair A. Khan

Meta Tag

Author List Abu Baker Sheikh, Erick Lopez, Umair A. Khan

Category Clinical Vignettes

Concept Sinus Pause

Concept Remdesivir

Concept Bradycardia

Concept Sinus Arrest

Concept COVID-19

Distinguished Non-Finalist

Presenter Organization University of New Mexico Hospital

Presenting Author Umair A. Khan

Track Adult

Keywords

remdesivir

bradycardia

sinus pause

COVID-19 pneumonia

hypoxia

schizophrenia

dexamethasone

telemetry monitoring

mitochondrial toxicity

adenosine-like effects

Sinus Pause

Remdesivir

Bradycardia

Sinus Arrest

COVID-19