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Rationale: Cardiovascular and chest involvement in a pandemic COVID-19 virus infection may be vital.Bifascicular heart block is affecting the conduction delay or block below the AVN in two of the three fascicles. There is a correlation between mortality with sudden cardiac death (SCD) and bifascicular block. SISIISIII pattern is meaning that the S-waves of amplitude is more than 1.5 mm in I, II, and III. It is a variable prognostic electrocardiographic finding.   Patient concerns: A 67-year-old, retired officer, smoker, married, Egyptian male patient was admitted to the intensive care unit with right bundle branch block, left anterior fascicular block, and mild COVID-19 pneumonia with slight pleural effusion.   Diagnosis: Bifascicular block with ECG SISIISIII pattern in mild COVID-19 pneumonia with slight pleural effusion.   Interventions: Electrocardiography, oxygenation, non-contrast chest CT, and echocardiography.  Outcomes: Good response and better outcomes despite the presence of several remarkable risk factors were the results.   Lessons: Associated hypoxia in the current COVID-19 pneumonia may play an essential role in the present new bifascicular heart block. SISIISIII pattern represents a variable prognostic ECG finding such as RVH, pulmonary embolism, and congenital heart disease. The presence of left ventricular septal hypertrophy is considered another risk. The presence of the elderly male sex, heavy smoker, COVID-19 pneumonia, pleural effusion, bifascicular heart block, SISIISIII pattern, and interventricular septal hypertrophy are prognostic factors for the severity of the disease.

Bifascicular Block with Electrocardiographic Sisiisiii Pattern in Mild Covid-19 Pneumonia with Slight Pleural Effusion; Differentiation versus Outcome