Hypoxic bradycardia: an enigma in coronavirus disease 2019

Coronavirus disease 2019 varies from asymptomatic to severe acute respiratory syndrome with multiple organ involvement, primarily involving the microvasculature and heart. Acute myocardial injury is most frequently observed reported cardiac complication coronary events, left ventricular systolic dysfunction, arrhythmias, but sinus bradycardia only in a few cases. The development of can be crucial warning sign onset cytokine storm. primary determinant severity COVID-19 aging co-morbidities such as diabetes hyperlipidemia dysregulated immunological status. Patients pre-existing cardiovascular infected have increased risk mortality. Literature available regarding occurrence limited, electrophysiology studies patients shown bradycardia, heart block, bundle branch intraventricular conduction delay. pathophysiological mechanism not yet known entirely. Cardiac manifestations could attributed clinical etiologies, including direct viral damage, inflammatory response, hypoxia, hypotension, downregulation angiotensin-converting enzyme 2 (ACE-2), drug toxicity, endogenous toxicity catecholamine adrenergic status, also hypoxic damage lungs by act trigger. We report one case due detected through intensive monitoring managed successfully ICU tertiary care dedicated hospital. Bradycardia rare phenomenon, worst prognostic marker. If early may help prognostication and, if appropriately, will avert life-threatening complication.