A case of paroxysmal supra-ventricular tachycardia and massive pulmonary embolism in SARS-CoV-2 infection

Pulmonary embolism (PE) has been described as a common and relevant complication of SARS-CoV-2 infection. In addition to the damage directly caused by the virus, other factors are also involved in this disease, such as immune system, hypoxia, bed rest, inflammation, age, smoking habit, and endothelial dysfunction. Here, we describe the case of a 68-years-old female patient hospitalized for severe respiratory failure and SARS-CoV-2 infection. She had performed a chest CT scan in the emergency room which documented the presence of massive and diffuse embolism in both branches of the pulmonary artery with greater involvement on the left. in addition to the clear signs of bilateral interstitial pneumonia more extensive on the right lung. After three days, the patient appeared sedated and showed severe hypotension (80/60 mm/Hg). An electrocardiogram documented the presence of paroxysmal supra-ventricular tachycardia (AVNRT) at a rate of 160 /min. A rapid infusion of amiodaron began (2.5 mg / kg in 250 of glucose) at the same time, the carotid sinus massage was performed, which continued to be unsuccessful. The coexistence of an extensive embolism and the sudden increase in frequency have suddenly compromised cardiac hemodynamics, with severe hypotension. The pharmacological interruption of the arrhythmia resulted in a prompt recovery of blood pressure values. The correct and timely management of arrhythmia and cardiac complications might modify the outcome of the disease.