A 65-year-old man, Filipino, with comorbidities consulted because of shortness of breath. Chest computed tomography scan showed ground-glass opacities and crazy paving patterns (computed tomography severity score = 29). He required oxygen at 4 L/min, with bradycardia. Cardiac enzymes and transthoracic echocardiogram did not show abnormalities. Serial electrocardiogram and electrolytes showed arrhythmia and electrolyte imbalance. Accumulated evidence showed that cardiac involvement is common in patients with COVID-19.1,2 Atrial and ventricular arrhythmia is common even if there is no history of arrhythmia, normal cardiac biomarkers, and transthoracic echocardiogram. Different mechanisms have been proposed for the cause of electrolyte imbalance (see Discussion) that may lead to arrhythmia. Both potassium and calcium were used as a marker of clinical severity and worse prognosis in patients with COVID-19.3,4.

Arrhythmia in COVID-19 patients are more frequent in elderly with comorbidities. Close monitoring and correction of electrolyte imbalance are important to prevent arrhythmia, which can sometimes be fatal.