Remdesivir-associated asymptomatic bradycardia in an icu patient on dexamethasone for covid-19

SESSION TITLE: Cardiovascular Complications in Patients with COVID-19 SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Even though COVID-19 is the largest pandemic of the twenty-first century, little is known about the disease or its management. Remdesivir has demonstrated some activity against severe ARDS associated with COVID-19. There is a dearth of data on the adverse effects of Remdesivir. We report a case of a COVID-19 patient who developed bradycardia following the administration of Remdesivir. CASE PRESENTATION: A 64-year-old man, who tested positive for COVID-19, presented with shortness of breath (SOB) for a week. SOB was accompanied by a cough with tan-colored sputum. Past medical history included hypertension and benign prostatic hyperplasia. Physical examination showed regular rate and rhythm of the heart and diffusely decreased breath sounds. His blood pressure was 104/60 mmHg and his heart rate was 80 bpm. Oxygen saturation was 58% at room air. Significant lab results showed elevated CRP: 17.13 mg/dl, D-Dimer: 10.16 ug/mL FEU, Lactic acid: 2.5 mg/dl, Creatinine: 1.8 mg/dl, BUN: 60 mg/dl, and AST: 46 U/L. Chest x-ray showed bilateral patchy interstitial airspace opacities. Calculated Well's score of 3 indicated a moderate risk for pulmonary embolism. CT scan showed moderate bilateral diffuse areas of ground-glass lung consolidation concerning diffuse atypical infection. The patient was admitted to the ICU and started on CPAP with PEEP of 12 and FiO2 of 100%. The management included dexamethasone 6 mg oral for 10 days, Remdesivir for 5 days, and Tocilizumab given elevated CRP level. The patient was found to develop asymptomatic bradycardia with a heart rate as low as 40 bpm. An EKG obtained demonstrated sinus bradycardia without any heart block. Echocardiography showed mildly dilated right ventricle & mild aortic regurgitation. Bradycardia resolved after the last dose of Remdesivir. DISCUSSION: Remdesivir is frequently used in severe COVID-19 infections. The commonly reported adverse events affect the gastrointestinal and renal systems. The reported cardiovascular adverse events include hypotension, atrial fibrillation, and cardiac arrest. However, bradycardia is becoming increasingly encountered. Although corticosteroids are known to cause bradycardia, the patient we managed developed bradycardia following remdesivir therapy. The baseline EKG was normal and the history was non-contributory. Given the asymptomatic nature of the finding, cardiac monitoring alone sufficed. The heart rate picked up following the last dose of remdesivir further suggesting its causative role. CONCLUSIONS: Bradycardia is becoming more common with Remdesivir use. If the patient is not exhibiting any symptoms, cardiac monitoring alone should suffice; bradycardia is expected to resolve when the drug is stopped. Reference #1: Elsawah HK, Elsokary MA, Abdallah MS, ElShafie AH. Efficacy and safety of remdesivir in hospitalized Covid-19 patients: Systematic review and meta-analysis including network meta-analysis. Rev Med Virol. 2021;31(4):e2187. Reference #2: Taqi M, Gillani SFUHS, Tariq M, Raza ZA, Haider MZ. Current updates on clinical management of COVID-19 infectees: a narrative review. Rev Assoc Med Bras (1992). 2021 Aug;67(8):1198-1203. doi: 10.1590/1806-9282.20210582. PMID: 34669870. DISCLOSURES: No relevant relationships by AISHA ADIGUN No relevant relationships by Mobeen Haider No relevant relationships by Yousra Khalid No relevant relationships by Muhammad Hasib Khalil No relevant relationships by Aleena Naeem No relevant relationships by Zarlakhta Zamani