Abstract
Introduction: SARS-CoV2 infection has been associated with cardiovascular manifestations, including myocarditis and arrhythmias. Asymptomatic brugada pattern of EKG has been reported and usually associated with fever, sodium channel blockers, and psychotropic drugs. There have been few reported cases of brugada pattern unmasked by fever in patient with covid-19 infection. We present a unique case of a patient with brugada pattern of EKG in an afebrile patient with Covid 19 myocarditis. Case presentation: Patient is a 58 year old male with PMHx significant for ITP, HTN who was admitted on account of dyspnea and dysphagia. Patient was subsequently with covid-19 infection/pneumonia and epiglottitis. Decision Making: Physical examination findings showed a hyperemic epiglottis. Initial labs were positive for covid 19 with elevated troponins (>3000). Initial EKG showed ST elevation on V1-V4 (figure 1a) raising suspicion for possible STEMI vs covid myocarditis with brugada pattern. Echocardiogram performed showed a severely reduced ejection fraction at 20% with global hypokinesis. Emergent left heart catherization was performed which showed no angiographic evidence of coronary artery disease. The patient was started on guideline therapy for covid 19 infection and also antibiotics for presumed epiglottitis. Inflammatory markers continued to trend downwards. Patient was also started on guideline directed medical therapy for heart failure. Repeat EKG showed resolution of Brugada pattern (figure 1c). Clinical course improved throughout hospital stay. Conclusion: There has been few reported cases of brugada pattern un-masked by Covid-19 infection. These reported cases are commonly associated with the occurrence of fever, which has been attributed to the dysregulation of Na channels. This case presents a diagnostic dilemma as most patient with covid and brugada have documented febrile episodes prior to the unmasking of this rare arrhythmia.
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