Relative bradycardia as a clinical feature in patients with coronavirus disease 2019 (COVID-19): a report of two cases

Hiraiwa, Hiroaki; Goto, Yukari; Nakamura, Genki; Yasuda, Yuma; Sakai, Yoshinori; Kasugai, Daisuke; Jinno, Shinsuke; Tanaka, Taku; Ogawa, Hiroaki; Higashi, Michiko; Yamamoto, Takanori; Jingushi, Naruhiro; Ozaki, Masayuki; Numaguchi, Atsushi; Kondo, Toru; Morimoto, Ryota; Okumura, Takahiro; Matsuda, Naoyuki; Murohara, Toyoaki

We treated two patients with COVID-19 pneumonia requiring mechanical ventilation. Case 1 was a 73-year-old Japanese man. Computed tomography (CT) revealed ground-glass opacities in both lungs. He had severe respiratory failure with a partial pressure of oxygen in arterial blood/fraction of inspiratory oxygen ratio (P/F ratio) of 203. Electrocardiogram showed a heart rate (HR) of 56 beats/min, slight ST depression in leads II, III, and aVF, and mild saddle-back type ST elevation in leads V1 and V2. High-sensitivity cardiac troponin T (cTnT) level was slightly elevated. Despite a high fever and hypoxemia, his HR remained within 50–70 beats/min. Case 2 was a 52-year-old Japanese woman. CT revealed ground-glass opacities in the lower left lung. Electrocardiogram showed a HR of only 81 beats/min, despite a body temperature of 39.2 °C, slight ST depression in leads V4, V5, V6, and a prominent U wave in multiple leads. She had an elevated cTnT and a P/F ratio of 165. Despite a high fever and hypoxemia, her HR remained within 50–70 beats/min. Both patients had a poor compensatory increase in their HR, despite their critical status. Relative bradycardia could be a cardiovascular complication and is an important clinical finding in patients with COVID-19.