Abstract
Introduction: Remdesivir is an antiviral, nucleotide analogue agent that has been extensively used during the SARS-CoV-2 (COVID 19) pandemic with proven efficacy against COVID-19-induced and has been shown to reduce recovery times for hospitalized patients with severe COVID-19 illness. Commonly reported adverse effects of Remdesivir to include nausea, vomiting, and laboratory transaminase elevations. Other reported adverse effects include anemia, acute kidney injury, fever, and hyperglycemia. However, scant evidence exists regarding the cardiotoxic profile of Remdesivir.
Case Presentation: In this case, we detail the clinical course of a 50-year-old female with a past medical history of atrial fibrillation, hypertension, coronary artery disease (CAD), and chronic obstructive pulmonary disease (COPD) who presented to the emergency room with worsening hypoxia and shortness of breath (SOB). She was subsequently diagnosed with COVID-19 and admitted for treatment. As the patient's status continued to deteriorate, she met the criteria for treatment with Remdesivir. The patient subsequently developed asymptomatic bradycardia with a pulse of 30 to 40 bpm. Despite stopping the patient’s home beta-blocker medication and ensuring she was not on any other heart rate-limiting therapeutics, she developed a sinus pause for three seconds. Remdesivir was discontinued and she did not develop any further sinus pauses. There are recent reports of an association between Remdesivir and AV nodal blockade, possibly attributed to an active metabolite, a nucleotide triphosphate derivative that is similar to adenosine triphosphate. The patient`s bradycardia started to improve gradually within 48 hours after discontinuation of Remdesivir.
Discussion: When considering the use of Remdesivir, the potential for its cardiotoxic adverse effects, namely bradycardia, should be acknowledged. Other efficacious agents may be considered in patients with increased risk for cardiovascular compromise who need antiviral therapy to treat COVID19.
Conclusion: Remdesivir should be acknowledged for its arrhythmia-producing cardiotoxic profile and should be employed tactically in the management of COVID-19 in patients with pre-existing comorbidities that affect the cardiac conduction system. Intensive cardiac surveillance is necessary for patients who develop Remdesivir-associated bradycardia.
