Fatal Intruder to The Heart in Covid-19 Pandemic

Introduction: Coronavirus disease (COVID-19) is the disease caused by a new coronavirus called SARS-CoV-2, which commonly demonstrates respiratory complications from mild URTI to severe ARDS. Yet, there is increasing number of patients who presented to our ED with cardiac complaints only. We described a series of 3 COVID 19 cases with cardiovascular involvement which visited to our centre. Case Report: Case 1: A 21-year-old gentleman with no known medical illness complaint of chest discomfort for 1 day, and associated with palpitation and shortness of breath. He had close contact 3 days prior to presentation. Upon arrival at ETD, his heart rate was 62 beats/min and other vital signs were normal. His 1st ECG showed sinus arrhythmia, with no acute ischemic changes (Fig. 1A). Subsequently, he developed bradycardia with heart rate ranged 35-45 beats/min. His 2nd and 3rd ECG showed sinus bradycardia, with no any atrioventricular block (Fig. 1B, 1C). His COVID-19 PCR was positive. Case 2: A 51-year-old gentleman with underlying hypertension and Type II Diabetes Mellitus, presented with burning sensation over epigastrium for 1 day. Upon arrival at ETD, he was hemodynamically stable. His 1st ECG showed sinus tachycardia; isolated ST elevation over lead V3(3 small boxes); ST depression over lead III and aVF; Q waves over lead III and aVF (Fig. 2A). Subsequently, his 2nd ECG demonstrated sinus rhythm with significant ST elevation over lead V2 (3 small boxes); but complete resolution of ST elevation over lead V3; and ST depression over lead III and aVF (Fig. 2B). His 3rd ECG was same as 2nd ECG, but there is decreased in amplitude of R wave over lead V5 and V6 (Fig. 2C). Troponin I showed negative (