Remdesivir induced dangerously low heart rate in COVID-19 patient

Prompt recognition of remdesivir-induced hemodynamically unstable sinus bradycardia is crucial during treatment of COVID-19, doctors advise in Heart Rhythm Case Reports


Philadelphia, June 24, 2021

After beginning treatment with remdesivir for COVID-19, a patient experienced significant bradycardia, or low heart rate. Her physicians used a dopamine infusion to stabilize her through the five-day course of remdesivir treatment, and her cardiac condition resolved itself at the end of the treatment. The case is discussed in Heart Rhythm Case Reports, an official journal of the Heart Rhythm Society, published by Elsevier.

“Remdesivir has become the standard of care for COVID-19 pneumonia and there is a paucity of data on its cardiac effects,” explained lead author Jomel Patrick Jacinto, DO, HCA Healthcare/USF Morsani College of Medicine GME Programs at Regional Medical Center Bayonet Point, Hudson, FL, USA. “While it is known to be well tolerated and effective, it’s critical to note its potential adverse effects on the cardiovascular system. To our knowledge, this is the first reported case of remdesivir-induced hemodynamically unstable sinus bradycardia.”

The patient arrived at the hospital in respiratory distress with abnormally rapid breathing, and she tested positive for COVID-19. She was admitted to the intensive care unit and was started on standard COVID-19 treatment protocol, including antiviral therapy with remdesivir. Twenty hours after administration of the first dose, her vitals revealed very low blood pressure and a heart rate as low as 38 beats per minute. An electrocardiogram found marked sinus bradycardia. She lacked any prior cardiac history and had normal telemetry monitor and ECG findings prior to receiving remdesivir. She was started on a dopamine drip and maintained normal sinus rhythm with a heart rate of 60-65 beats per minute. Eighteen hours after her last dose of remdesivir, the dopamine was titrated off, and the patient was stable, with normal ECG findings.

Dr. Jacinto observed that remdesivir has an important role in the fight against severe COVID-19 because it has been shown to improve mortality rates and shorten the total time to recovery. In this case, completion of the five-day course of remdesivir was imperative to the patient’s treatment despite the adverse effects as concurrent medical treatment with pressors such as dopamine was adequate support.


Remdesivir has an important role in the fight against severe COVID-19 because it has been shown to improve mortality rates and shorten the total time to recovery. A physician’s ability to recognize the potential of remdesivir to cause dangerously low heart rates and low blood pressures is important while treating patients suffering from COVID-19 (Credit: iStock.com/ Bernard Chantal).

“Most hospitals have the ability to support the patient through the five-day treatment course to completion, using medications such as dopamine to nullify severe bradycardia,” Dr. Jacinto said. “Having a heightened awareness of its cardiac safety profile is essential to make effective clinical decisions in treatment of patients with remdesivir.” He added that remdesivir should be used cautiously in patients with known cardiovascular disease.

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Notes for editors
The article is “Remdesivir-Induced symptomatic bradycardia in the treatment of COVID-19 disease,” by Jomel Patrick Jacinto, DO, Milan Patel, MD, Justin Goh, MD, and Kenneth Yamamura, MD, FACC (https://doi.org/10.1016/j.hrcr.2021.05.004). It appears online in advance of Heart Rhythm Case Reports, volume 7, issue 8 (August), published by Elsevier.

The article is freely available to all at www.heartrhythmcasereports.com/article/S2214-0271(21)00100-7/fulltext.

For additional information contact Jane Grochowski at +1 406 542 8397 or hmsmedia@elsevier.com. Journalists who wish to interview the case report authors should contact Jomel Patrick Jacinto at jomel.jacinto@gmail.com.

Elsevier’s Novel Coronavirus Information Center provides expert-curated information for researchers, healthcare professionals and public health officials, including clinical guidance and a portal to access all of Elsevier’s COVID-19 research. All resources are freely available. We also have dedicated hubs for healthcare professionals; health educators and students; librarians; and R&D professionals. You can find these in our Coronavirus Resource Directory.

About Heart Rhythm Case Reports
Heart Rhythm Case Reports is an official Journal of the Heart Rhythm Society. It is an open access companion journal to the respected Heart Rhythm. It provides rapid online electronic publication of the most important current case reports, illustrations, and educational vignettes in the field of cardiac arrhythmias and electrophysiology. The Journal publishes case reports and series devoted to the diagnosis and treatment of heart rhythm disorders, as well as the electrophysiology of the heart and blood vessels. All articles are peer-reviewed. www.heartrhythmcasereports.com

About the Heart Rhythm Society
The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal healthcare policies and standards. The Heart Rhythm Society is the preeminent professional group representing more than 6,500 specialists in cardiac pacing and electrophysiology from more than 70 countries. www.HRSonline.org

About Elsevier
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In everything we publish, we uphold the highest standards of quality and integrity. We bring that same rigor to our information analytics solutions for researchers, health professionals, institutions and funders.

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Media contact
Jane Grochowski, Publisher
Elsevier
+1 406 542 8397
hmsmedia@elsevier.com