PMC8486562_01
(a) Complete heart block with low ventricular rate of 41: hospital day #4:subsequently started isoproterenol. (b) Second-degree type 2 AV block: hospital day #5:on isoproterenol. (c) Second-degree Mobitz type 1 AV block: hospital day #7:on isoproterenol. (d) First-degree AV block: hospital day #8:on isoproterenol.
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fig1
Approximately 12 hours from the last dose of azithromycin, the patient became bradycardic to 30s-50s; however, ECG revealed a complete AV block with a ventricular rate of 41 bpm and a junctional escape rhythm (Figure 1(a)). AV block (Figure 1(b)), and the patient remained asymptomatic. A second dose of IVIG was administered. AV block (Figure 1(c)). An IL-6 inhibitor, tocilizumab, was administered. LVEF on echocardiogram prior to discharge home was normal, yet the patient had a PR interval of 278 ms indicative of first-degree heart block (Figure 1(d)).
PMC8486562_02
Bradycardia with prolonged QTc.
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fig2
Bradycardia persisted into the next day as the QTc worsened to 592 ms (Figure 2).
PMC8486562_03