Intermittent Silent Coronary Spasm with Variant Premature Ventricular Contractions, and QRS-Complex Fragmentation in COVID-19 Pneumonia with Stroke and Pleural Effusion; Serious Risk but a Good Outcome

Abstract

Rationale : A pandemic COVID-19 virus is a multi-systemic lethal worldwide infection. Cardiac, neurological, chest, and renal systems are frequently involved. Silent coronary artery disease is sometimes reported in diabetic and elderly patients. There is a strong correlation between COVID-19 pneumonia, thromboembolism, and ischemic heart disease. Ischemic stroke and coronary artery disease are commonly clinically recognized in COVID-19 patients who have a risk impact on both morbidity and mortality. The QRS-complex fragmentation is considered as a marker for cardiac structural diseases inducing biventricular hypertrophy or any condition interfering with the normal homogeneous depolarization status inside the myocardium. Patient concerns: A 68-year-old, non-working, smoker, married, Egyptian male patient was admitted to the intensive care unit with cerebrovascular stroke, premature ventricular contractions, and COVID-19 pneumonia. Diagnosis: Intermittent silent coronary spasm with ischemic variant premature ventricular contractions, and QRS-complex fragmentation in COVID-19 pneumonia with stroke and pleural effusion. Interventions: Electrocardiography, oxygenation, non-contrast chest CT, and brain CT. Outcomes: Good response and better outcomes despite the presence of several remarkable risk factors were the results. Lessons: Intermittent silent coronary spasm is an interesting issue and maybe multi-factorial. The presence of elderly male sex, heavy smoker, COVID-19 pneumonia, pleural effusion, recurrent ischemic cerebrovascular stroke, renal impairment, ischemic heart disease, hypocalcemia, diabetes, ischemic variant premature ventricular contractions, and QRS-complex fragmentations are prognostic factors for the severity of the disease. The clinical and electrocardiographic response after using anti-COVID19 measures the signifying its role and suggests the diagnosis of COVID19 infection.