Paxlovid-Induced Symptomatic Bradycardia and Syncope.

Paxlovid (nirmatrelvir/ritonavir) is a game changer in the fight against COVID-19 due to its ease of administration and significant benefits of reducing progression to severe COVID-19, hospitalization, and death. Cardiac adverse events such as bradycardia and syncope are not known with this medication. We report a case of a 71-year-old patient who developed symptomatic bradycardia, syncopal episodes, and sinus pause after taking Paxlovid. Discontinuing medication and intravenous atropine helped to reverse the bradycardia and symptoms promptly. She did not require a pacemaker. We would like to report this possible association between Paxlovid and bradycardia. Until further information or studies are available, it is advised to promptly discontinue Paxlovid after any evidence of bradycardia and closely monitor for at least 40 hours in a hospital setting. The reported half-life (t 1/2) of the medication is 6.05 ± 1.79 hours and using 8 hours as a reference for the upper limit of t 1/2, around 97 % of the medication should be cleared off in about 40 hours (five half-lives).

Rare dizziness, syncope, loss of consciousness, seizure, and risk of falling after vaccination

Some individuals experience dizziness, syncope (temporary loss of consciousness caused by a fall in blood pressure), seizure, and similar rare adverse events after vaccination. Sudden impacts to alertness, consciousness, ability to talk, vision, or balance may pose rare risks for some vaccinees for a few days post vaccination. Herein, the Vaccine Adverse Event Reporting System (VAERS) database is examined for relevant adverse events. These adverse events exhibit a consistent pattern of onset soon after vaccination consistent with other reported reactogenicity adverse events. The onset of these adverse events soon after vaccination provides supportive evidence to reject the hypothesis that the majority of these adverse events represent background occurrences unrelated to vaccination. The immediate onset timing of these adverse events represent a pattern that warrants further study. The observed onset pattern for multiple unrelated vaccines are consistent with the possible etiology of innate immune responses to vaccination as causative for these observed adverse events. Cautionary avoidance of some activities immediately following vaccination may reduce accidental injuries.

Recurrent ventricular tachycardia in a patient with COVID-19 vaccine-associated myocarditis: a case report.

Background: The development of coronavirus disease 2019 (COVID-19) vaccine-associated myocarditis has been reported. Most of the reported cases are mild, with quick clinical recovery and excellent short-term outcomes. Cases of COVID-19 vaccine-associated myocarditis presenting with sustained ventricular tachycardia (VT) are rare. Case Description: A 46-year-old male patient with no prior cardiac history presented following two episodes of syncope. Two days earlier, he had received his second dose of COVID-19 mRNA vaccine (Pfizer)-first dose was administered three weeks earlier. He had an episode of VT while in the emergency room. His cardiac magnetic resonance imaging (MRI) findings were consistent with myocarditis. He was eventually diagnosed with COVID-19 vaccine-associated myocarditis after all other work up were unremarkable [echocardiogram, coronary angiogram, diagnostic electrophysiology study and later 18F-fluorodeoxyglucose (FDG) metabolism cardiac sarcoid positron emission tomography (PET) study]. An implantable cardiac monitor was implanted to monitor for recurrence of VT. Seven months after initial presentation, he had recurrent VT and he underwent implantation of an implantable cardioverter defibrillator (ICD). He has received appropriate ICD therapies on account of recurrent VT and he is currently maintained on an antiarrhythmic medication. Conclusions: Excellent short-term outcomes have been reported in patients with COVID-19 vaccine associated myocarditis. Our case shows that long-term outcomes may not be benign in everyone, particularly in those who develop myocardial scar.

INSIGNIFICANT AND SERIOUS REASONS FOR CARDIOLOGICAL CONSULTATIONS IN CHILDREN AND ADOLESCENTS DURING THE COVID-19 PANDEMIC. SELECTED PROBLEMS.

Cardiological problems in children are a common reason for consultations on duty. Cur-rently, due to the pandemic caused by SARS-CoV-2 virus, it is necessary to limit unnec-essary contacts and any consultations should be justified. On the other hand, there are cardiological conditions that may be dangerous to the child's health, because among the trivial reasons for consultations, there may be significant irregularities that require detailed diagnostics and treatment. For this reason, a family doctor or a paediatrician should make a thorough initial assessment taking into account whether a cardiological consultation is necessary. If so, does it have to be performed urgently, or can it be a planned examination.Copyright © 2021, Wydawnictwo Czelej Sp. z o.o.. All rights reserved.

Syncope With Sinus Arrest Following a Single Dose of a COVID-19 Vaccine.

Vaccines against the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) are of paramount importance in combating the current coronavirus disease 2019 (COVID-19) pandemic. Syncopal episodes following routine vaccinations are well-reported; however, only a few cases of syncope following SARS-CoV-2 vaccines exist in the literature. This is a case report of a 21-year-old female patient who developed recurrent syncopal attacks over three months that started one day after receiving the first dose of the Pfizer-BioNTech COVID-19 vaccine (Pfizer, New York City; BioNTech, Mainz, Germany). Holter monitoring during successive episodes showed progressive bradycardia followed by a prolonged sinus arrest. The patient eventually required pacemaker placement that resulted in the total resolution of her symptoms. Further studies are required to investigate a possible correlation and the mechanisms involved.

Impact of the COVID-19 pandemic on clinical autonomic practice in Europe A survey of the European Academy of Neurology (EAN) and the European Federation of Autonomic Societies (EFAS).

OBJECTIVE: To investigate the impact of the coronavirus-disease-2019 (COVID-19) pandemic on European clinical autonomic practice. METHODS: Eighty-four neurology-driven or interdisciplinary autonomic centers in 22 European countries were invited to fill in a web-based survey between September and November 2021. RESULTS: Forty-six centers completed the survey (55%). During the first pandemic year, the number of performed tilt-table tests, autonomic outpatient and inpatient visits decreased respectively by 50%, 45% and 53%, and every-third center reported major adverse events due to postponed examinations or visits. The most frequent newly-diagnosed or worsened cardiovascular autonomic disorders after COVID-19 infection included postural orthostatic tachycardia syndrome (POTS), orthostatic hypotension, and recurrent vasovagal syncope, deemed likely related to the infection by ≥50% of the responders. Forty-seven percent of the responders also reported about people with new-onset of orthostatic intolerance, but negative tilt-table findings, and 16% about people with psychogenic pseudosyncope after COVID-19. Most patients were treated non-pharmacologically and symptomatic recovery at follow-up was observed in ≥45% of cases. By contrast, low frequencies of newly-diagnosed cardiovascular autonomic disorders following COVID-19 vaccination were reported, most frequently POTS and recurrent vasovagal syncope, and most of the responders judged a causal association unlikely. Non-pharmacological measures were the preferred treatment choice, with 50-100% recovery rates at follow-up. CONCLUSIONS: Cardiovascular autonomic disorders may develop or worsen following a COVID-19 infection, while the association with COVID-19 vaccines remains controversial. Despite the severe pandemic impact on European clinical autonomic practice, a specialized diagnostic work-up was pivotal to identify non-autonomic disorders in people with post-COVID-19 orthostatic complaints.

Brugada pattern in adolescent with acute myocarditis due to SARS-CoV-2.

Brugada syndrome is a genetic disorder characterized by abnormal findings on electrocardiogram (ECG) that can precipitate ventricular tachyarrhythmias and sudden cardiac death. Most clinical manifestations of Brugada syndrome are related to life-threatening tachyarrhythmias, such as ventricular fibrillation or polymorphic ventricular tachycardia, but Brugada syndrome can also present with syncope or less likely palpitations. Our case is of a previously healthy 17-year-old visiting from Puerto Rico who presented to the emergency department (ED) with a syncopal episode preceded by sore throat, dizziness, and lightheadedness without palpitations. The ED evaluation found a normal complete blood count and basic metabolic panel. The patient tested positive for COVID-19 by polymerase chain reaction. An ECG was performed that showed the Brugada pattern, which was later confirmed by cardiology. Although Brugada syndrome and pattern are well known to the medical population, the findings of Brugada pattern in the setting of COVID-19 is not well described. Recognition and treatment are important, as Brugada syndrome can lead to life-threatening arrhythmias and sudden cardiac death.

The Impact of COVID-19 Pandemic on Hospitalization and Interventional Procedures for Cardiovascular Diseases during the First Wave in Italy.

Coronavirus disease 2019 (COVID-19) has been responsible for an epidemic of devastating proportion, and it has represented a challenge for worldwide healthcare systems with the need of resources reallocation in order to face epidemic spread. Italy was one of the hardest hit countries by COVID-19, and the Italian government adopted strict rules to contain the spread of the COVID-19 pandemic, such as national lockdown and home quarantine; moreover, the Italian healthcare system had to rapidly re-organize the diagnostic and therapeutic pathways, with a reallocation of health resources and hospital beds, in order to manage COVID-19 patients. The aim of the present review is to provide an overview of the effects of the first pandemic wave on cardiovascular assistance in Italy with the purpose of evaluating the strengths and weaknesses of the Italian health system.

Postural orthostatic tachycardia syndrome and orthostatic hypotension post COVID-19.

BACKGROUND: Novel coronavirus causes coronavirus disease -19 (COVID-19). The hallmark is acute respiratory distress syndrome, but other system's involvement is less illustrated. Our goal was to evaluate the manifestation of COVID-19 on one of the overlaps of the cardiovascular and nervous system, namely: Postural Orthostatic Tachycardia Syndrome (POTS) and Orthostatic Hypotension (OH). METHODS: This single-center cross-sectional observational study encompassed 60 consecutive patients that were hospitalized and recovered from severe or critical COVID-19. At the time of discharge, Blood Pressure (BP), Heart Rate (HR) in the supine and upright position (1st, 3rd, 5th and 10th minutes) were measured. Symptomatic patients were reevaluated 2 months later. RESULTS: The mean age of patients was 56.6 (±16.2) years and 42 patients were male (70%). The most frequent cardiovascular risk factor was hypertension (35%). OH and POTS were detected in 29(48.3%) and 10(16.7%) of the patients respectively at the time of hospital discharge. The mean age of patients with OH was higher than POTS and POTS was frequent in the elderly. Two months later among 10 patients with POTS, the sign and symptoms were resolved in 8(80%). Two (20%) patients who still had positive signs and symptoms of POTS were older than 65 years. Among 29 patients with OH, the signs and symptoms were resolved in 26(89.7%). CONCLUSION: In our study 65% of patients had OH or POTs on the day of hospital discharge, Complete recovery is gradual and needs several additional weeks. This is one of the aspects of the entity recently named "Long COVID".

Clinical presentation and management strategies of cardiovascular autonomic dysfunction following a COVID-19 infection - A systematic review.

BACKGROUND: Cardiovascular autonomic dysfunction may reportedly occur after a coronavirus-disease-2019 (COVID-19) infection, but the available evidence is scattered. Here we sought to understand the acute and mid-term effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on cardiovascular autonomic function. METHODS: We performed a systematic PubMed, Embase, Web of Science, medRxiv, and bioRxiv search for cases of cardiovascular autonomic dysfunction during an acute SARS-CoV-2 infection or post-COVID-19 condition. The clinical-demographic characteristics of individuals in the acute versus post-COVID-19 phase were compared. RESULTS: We screened 6470 titles and abstracts. Fifty-four full-length articles were included in the data synthesis. One-hundred and thirty-four cases were identified: 81 during the acute SARS-CoV-2 infection (24 thereof diagnosed by history) and 53 in the post-COVID-19 phase. Post-COVID-19 cases were younger than those with cardiovascular autonomic disturbances in the acute SARS-CoV-2 phase (42 vs. 51 years old, p = 0.002) and were more frequently women (68% vs. 49%, p = 0.034). Reflex syncope was the most common cardiovascular autonomic disorder in the acute phase (p = 0.008) and postural orthostatic tachycardia syndrome (POTS) the most frequent diagnosis in individuals with post-COVID-19 orthostatic complaints (p < 0.001). Full recovery was more frequent in individuals with acute versus post-COVID-19 onset of cardiovascular autonomic disturbances (43% vs. 15%, p = 0.002). CONCLUSIONS: There is evidence from the scientific literature about different types of cardiovascular autonomic dysfunction developing during and after COVID-19. More data about the prevalence of autonomic disorders associated with a SARS-CoV-2 infection are needed to quantify its impact on human health.

Demonstrating new-onset or worsened sudomotor function post-COVID-19 on comparative analysis of autonomic function pre-and post-SARS-CoV-2 infection.

Background: Autonomic dysfunction including sudomotor abnormalities have been reported in association with SARS-CoV-2 infection. Objective: There are no previous studies that have compared autonomic function objectively in patients pre- and post- SARS-CoV-2 infection.We aimed to identify if SARS-CoV-2 virus is triggering and/or worsening dysautonomia by comparing autonomic function tests in a group of patients pre-and post-SARS-CoV-2 infection. Design/methods: Six participants were enrolled and divided into two groups. The first group of 4 participants reported worsened autonomic symptoms post-SARS-CoV-2 infection. These individuals had their first autonomic test prior to COVID-19 pandemic outbreak (July 2019-December 2019). Autonomic function testing was repeated in these participants, 6 months to 1-year post-SARS-CoV-2 infection (June 2021).The second group of 2 participants reported new-onset autonomic symptoms post-COVID-19 infection and were also tested within 6 months post-SARS-CoV-2 infection.All participants had mild COVID-19 infection per WHO criteria. They had no evidence of large fiber neuropathy as demonstrated by normal neurophysiological studies (EMG/NCS). They were all screened for known causes of autonomic dysfunction and without risk factors of hypertension/hyperlipidemia, thyroid dysfunction, diabetes/prediabetes, vitamin deficiencies, history of HIV, hepatitis, or syphilis, prior radiation or chemical exposure or evidence of monoclonal gammopathy, or autoimmune condition. Results: Participants were female (age: 21-37y) and all endorsed orthostatic intolerance (6/6). Gastrointestinal symptoms (⅚), new-onset paresthesias, (3/6), and sexual dysfunction (2/6) were reported. Parasympathetic autonomic function remained stable 6-months to 1-year post-COVID-19 infection and no parasympathetic dysfunction was demonstrated in participants with new-onset dysautonomia symptoms. Postural orthostatic tachycardia was noted in half of the patients, being observed in one patient pre- SARS-CoV-2 infection and persisting post-SARS-CoV-2 infection; while new-onset postural tachycardia was observed in 1/3rd of patients. Sympathetic cholinergic (sudomotor) dysfunction was demonstrated in ALL participants. Worsened, or new-onset, sudomotor dysfunction was demonstrated in those with mild or normal sudomotor function on pre-COVID-19 autonomic testing. Conclusions: Sympathetic adrenergic and cholinergic dysautonomia probably account for some of the symptoms of Long COVID-19. Sudomotor dysfunction was demonstrated as consistently worsened or new-sequelae to COVID-19 infection. COVID-19 may be responsible for triggering new-onset or worsened small-fiber neuropathy in this sample, supporting previously reported studies with similar findings. However, the findings in our study are preliminary, and studies with larger sample size are needed to confirm these observations.

Immediate Adverse Events Following COVID-19 Vaccination in Australian Pharmacies: A Retrospective Review.

BACKGROUND: Four COVID-19 vaccines are approved for use in Australia: Pfizer-BioNTech BNT162b2 (Comirnaty), AstraZeneca ChAdOx1 (Vaxzevria), Moderna mRNA-1273 (Spikevax), and Novavax NVX-CoV2373 (Nuvaxovid). We sought to examine the type and management of immediate adverse events following immunisation (I-AEFI) after COVID-19 vaccination. METHODS: Retrospective review of I-AEFI recorded between July 2021 and June 2022 in 314 community pharmacies in Australia. RESULTS: I-AEFI were recorded in 0.05% (n = 526/977,559) of all COVID-19 vaccinations (highest: AstraZeneca (n = 173/161,857; 0.11%); lowest: Pfizer (n = 50/258,606; 0.02%)). The most common reactions were: (1) syncope, after the first dose of AstraZeneca (n = 105/67,907; 0.15%), Moderna (n = 156/108,339; 0.14%), and Pfizer (n = 22/16,287; 0.14%); and (2) Nausea/vomiting after the first dose of Pfizer (n = 9/16,287; 0.06%), Moderna (n = 55/108,339; 0.05%), and AstraZeneca (n = 31/67,907; 0.05%) vaccines. A total of 23 anaphylactic reactions were recorded (n = 23/977,559; 0.002%), and 59 additional I-AEFI were identified using MedDRA® terminology. Pharmacists primarily managed syncope by laying the patient down (n = 227/342; 66.4%); nausea/vomiting was managed primarily by laying the patient down (n = 62/126; 49.2%), giving water (n = 38/126; 30.2%), or monitoring in the pharmacy (n = 29/126; 23.0%); anaphylactic reaction was treated with adrenaline (n = 18/23; 78.3%) and n = 13/23 (56.5%) anaphylactic reactions were treated with the combination of: administered adrenaline, called ambulance, and laid patient down. CONCLUSION: The most commonly recorded I-AEFI was syncope after COVID-19 vaccination in pharmacy; I-AEFI are similar to those previously reported. Pharmacists identified and managed serious and non-serious I-AEFI appropriately and comprehensively.

Characteristics of chest pain in COVID-19 patients in the emergency department.

INTRODUCTION: Patients with coronavirus disease 2019 (COVID-19) can present with chest pain. However, the characteristics of this chest pain are unknown. We performed a single-centre observational study to review and summarise chest pain characteristics in COVID-19 patients at first presentation to the emergency department (ED). METHODS: We collected data on characteristics of 'chest pain' reported by COVID-19 patients who attended the ED of Bernhoven Hospital, the Netherlands from 4 through 30 March 2020. RESULTS: We included 497 COVID-19 patients, of whom 83 (17%) reported chest pain upon presentation to the ED. Chest pain characteristics were: present since disease onset (88%), retrosternal location (43%), experienced as compressing/pressure pain (61%), no radiation (61%) and linked to heavy coughing (39%). Patients who reported chest pain were younger than those without chest pain (61 vs 73 years; p < 0.001). Patients with syncope were older (75 vs 72 years; p = 0.017), had a shorter duration of symptoms (5 vs 7 days; p < 0.001) and reported fewer respiratory complaints (68% vs 90%; p < 0.001) than those without syncope. Patients with new-onset atrial arrhythmias presented with a shorter duration of symptoms (5 vs 7 days; p = 0.013), experienced fewer respiratory complaints (72% vs 89%; p = 0.012) and more frequently had a history of cardiovascular disease (79% vs 50%; p = 0.003) than patients who presented without arrythmias. CONCLUSION: Chest pain and other cardiac symptoms were frequently observed in COVID-19 patients. Treating physicians should be aware that chest pain, arrhythmias and syncope can be presenting symptoms of COVID-19.

PharmaCovigilance: Role of the Pharmacist During COVID-19 Vaccination Campaign: An International Journal of Medical Toxicology and Drug Experience

Introduction: COVID-19 vaccination campaign at Pederzoli Hospital (Veneto, Italy) started in January 2021 using the two approved m-RNA vaccines. The vaccination schedule included 2 doses and one booster. Objective: The Pharmacy unit created a digital form in order to collect information on the incidence of the adverse events after the anti-covid vaccination. Methods: The Pharmacy Unit created a simplified digital form including a set of questions about the occurrence of adverse events. To improve the adherence to this pharmacovigilance program, the digital form was uploaded on the hospital website and all the employees received a remainder about this vaccine adverse event reporting system via e-email regularly. The data collected from the electronic spreadsheet were analyzed by the Health Department in order to produce a report in the dedicated national website (Vigifarmaco). Results: From January 2021 to April 2022 1076 employees received the first dose, 965 received the second dose, and 1019 received the third dose. 323 adverse events reporting forms have been collected after the first dose (30% of those who received it). 291 forms (30%) were collected after the second dose. 12 forms (1.2%) were collected after the third dose. The most reported adverse events after the first dose were: local pain (38% of reported adverse events), muscle pain 15%;asthenia 12%, headache 11%. Moreover, 6 employees reported fever above 38.5 °C and 19 employees reported fever between 37.5 °C and 38.5 °C. The most reported adverse events after the second dose were: local pain 19%, muscle pain 18%;asthenia 15%, headache 13%. An employee reported a syncope. In addition,35 reported fever above 38.5 ° C and in 70 fever between 37.5 °C and 38.5 °C. After the third dose, 10 reported headache, 9 local pain, and 8 asthenia and muscle aches. Only 2 employees reported fever above 38.5 °C and 5 fever between 37.5 °C and 38.5 °C. Conclusion: The active role of the Hospital Pharmacy Unit during the vaccination campaign of the health care workers of our hospital permitted to collect data regarding the side effects of these new vaccines and nonetheless made the health care workers about more aware about the importance of vaccine adverse event reporting system. The use of this digital form supported the pharmacovigilance program creating a useful and "user friendly" tool which may be tailored to new future projects.

Pharmacovigilance Contribution During National Mass Immunization Days: An International Journal of Medical Toxicology and Drug Experience

Introduction: Rapid vaccination rollout against COVID-19 is the current main solution to overcome the pandemic morbidity and mortality but also to restart economies [1]. In Tunisia, 8 mass vaccination days have reinforced the national strategy. During these days, pharmacovigilance provided a real time monitoring regarding therapeutic advices and Adverse Events Following Immunizations (AEFIs). Objective: The objective of this study is to describe pharmacovigilance activities during these days. Methods: This is a descriptive study. The reporting system was a combination of both passive and active surveillance. Notifications concerned therapeutic advices and adverse events following immunization (AEFI). Results: We collected 855 reports among 3,423,884 vaccinated people during these 08-mass vaccination days, corresponding to an average of 25 reports per 100,000 administrated doses. Reports of 720 AEFI's were collected: 268 (37.2%) were collected from the passive monitoring and 313 (43.4%) from the active surveillance. The passive surveillance reported 80% of vasovagal reaction, 19,3% vaccine errors and others notifications concerned cutaneous eruption, face swelling... Vaccine errors (139) which occurred in 63.1% of cases during the 3rd National immunization day, concerned dilution errors, a double dose administration or errors in the vaccination pattern. AEFIs active monitoring revealed vasovagal reactions in 96.8% of cases, an elevated blood pressure, cutaneous eruption... The Pharmacovigilance team managed 135 therapeutic advices concerning history of drug reaction, previous vaccine reaction, comorbidities... Conclusion: The specificity of these immunization days was the increase of vasovagal cases and vaccination errors. Therefore, health authorities should deploy necessary means to prevent avoidable AEFIS during mass vaccination days.

Syncope and COVID-19: Case series and literature review

COVID-19 infection can present with atypical symptoms such as syncope. We reported 2 patients who presented to our emergency department with syncope as a chief complaint. One patient did not have any other symptoms while the other patient developed severe pneumonia later during hospitalization. The cardiac workup including electrocardiogram, cardiac monitoring, and echocardiogram were unremarkable. Both patients were diagnosed with neurally mediated/reflex syncope secondary to COVID-19. No recurrence was reported during follow-up. We then performed a literature review and described previous cases focusing on clinical presentation and the likely mechanism of syncope. © 2022 Journal of Nature and Science of Medicine. All rights reserved.

Highlights from this issue

Correspondence to Dr Ellen J Weber, Emergency Medicine, University of California San Francisco, San Francisco, California, USA;ellen.weber@ucsf.edu Much of what emergency physicians do is assess risk. In the study of NHS24 in Scotland assessing young patients with chest pain, Hodgins et al found that triage to the ED or an immediate home visit was associated with increased odds of patients being admitted to hospital with ‘a serious diagnosis’ while only 0.1% of patients directed to self-care were admitted to hospital in the next 7 days However, only 8.2% of patients were directed to self-care suggesting that although safe, there was substantial over-triage. [...]while many studies about prehospital intubation focus on patients in cardiac arrest, Strucker et al explore risk factors and outcomes of unrecognised endobronchial intubation in trauma patients. [...]our COVID-19 paper this month details the clinical outcomes of a nurse-led alternate care centre for assessing patients with COVID-19, which might prove an otion for some EDs should we see more surges in the current pandemic or as we plan for the inevitable next one.

Sinus Arrest in Asymptomatic COVID-19 Infection.

Coronavirus disease 2019 (COVID-19) is a viral respiratory tract syndrome capable of affecting a multitude of major organs in the human body. It is a known cause of severe vascular compromise, myocardial ischemia, myocarditis, and various cardiac dysrhythmias. Dysfunction of the sinoatrial (SA) node, the primary pacemaker of the heart, can arise from structural heart disease, medications, electrolyte abnormalities, and hypothyroidism. We report and discuss a case of a 50-year-old female with no significant past medical history (PMH) and no SA dysfunction risk factors, who experienced multiple syncopal events and an episode of sinus arrest characterized by transient asystole captured with telemetry monitoring. The patient was incidentally found to be COVID-19 positive and displayed no signs or symptoms concerning the viral illness. Despite our patient's lack of respiratory issues or other symptomatology, a significant and potentially fatal relationship exists between her viral infection and cardiac sequelae.