Sjogren’s syndrome may have caused heart block

Dear Dr. Roach: Is COVID-19 a cause of heart block? I recently had a complete heart block, tested positive in the ER for COVID-19, and was fitted with a permanent pacemaker. I’m a 63-year-old woman, in good health except for nonsevere Sjogren’s syndrome.

B.J.S. Heart block is a condition where the electrical impulse from the top chambers of the heart to the bottom are completely blocked. I found case reports and a case series of people developing heart block while in the hospital with COVID-19 infection. In the case series, all three patients were severely ill and all cases of heart block recovered without need for pacemaker. In a larger series of 700 COVID-19 patients, none developed heart block.

While it is plausible the COVID-19 infection may have caused your heart block, this complication seems to be uncommon. It may also be that it just happened to occur at the same time you had an asymptomatic case of COVID-19.

There are case reports of heart block developing in people with Sjogren’s syndrome. It’s possible that it was the Sjogren’s, not COVID-19, that caused the permanent heart block.

Dear Dr. Roach: I am one of a group of four cousins who socialize together. Three of us are vaccinated and boosted, and one is vaccinated but refuses to get the booster.

I have common variable immunodeficiency. Both my IgA and IgG are very low. I get IGG infusions, but I still get many infections. I have been on eight courses of antibiotics and several courses of prednisone from May to December 2021.

I have told the unboosted cousin I can’t socialize with him. He says I’m overreacting. What do you think?

D.S. Common variable immunodeficiency often has minimal symptoms, and many people have it and do not realize it. They may get somewhat more frequent respiratory infections than others. When the immunoglobulin levels (IgA and IgG are different types of immunoglobulins, also called antibodies) are low, the person with common variable immunodeficiency is at higher risk. Immunoglobulin IgG infusion (also called gamma globulin) helps to reduce risk, but it does not completely replace the immune system deficiency. In those cases, there is also the real risk that vaccines are going to be less effective or ineffective.

Because of your primary immunodeficiency, I agree with you that minimizing your exposure is critical. “Potentially life-saving” is not too strong a phrase to use, and your cousin should at the very least respect your medical needs.