- Coronavirus disease 2019 (COVID-19) caused by the coronavirus 2 (SARS-CoV-2) predominantly affects the respiratory system but may also result in cardiac complications, including myocarditis.1 SARS-CoV-2 binds to the angiotensin-converting enzyme-2 receptor expressed on the surface of alveolar and cardiac cells, which may account for the direct cardiac involvement in COVID-19.2 Myocarditis is an inflammatory disease caused by infectious and noninfectious etiologies.3 Fulminant myocarditis is the most severe type of myocarditis and is predominantly caused by viral infections.
- Thank you for the opportunity to expand on the discussion of Brugada syndrome in patients with Coronavirus 2019 (COVID-19). As Betancor and colleagues astutely pointed out, COVID-19-induced fever was depicted as the potential cause of electrocardiographic changes in our patient.1
- The current COVID-19 pandemic has placed extreme stress on the global health care system. Novel approaches to managing COIVD-19 patients are required. Preliminary results from a small trial suggest that a combination of hydroxychloroquine and azithromycin is efficacious for reducing the viral load in patients with COVID-19.1 Although the arrhythmogenic risk of these medications is low, both of these medications alone, and in combination, can prolong the QT interval.1–7 Patients receiving this regimen require, at a minimum, serial electrocardiograms (ECGs), which increases the risk of potential exposures for staff members and requires use of additional personal protective equipment.
- First described in the 1990s, the Brugada syndrome initially characterized unexplained sudden cardiac death in healthy Southeast Asian men.1 Mutations in the cardiac sodium channel were later identified in the SCN5A and SCN10A genes, accounting for nearly 50% of the cases.2,3 Brugada syndrome phenotype is associated with decrease in the sodium current owing to reduction in sodium channels and/or reduction of function of the sodium channels. Although the reduction in the sodium current manifests with characteristic electrocardiographic abnormalities, patients with the Brugada syndrome are often healthy and unaware of their genetic predisposition.