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High thrombus burden despite thrombolytic therapy in ST-elevation myocardial infarction in a patient with COVID-19

Gayatri Setia1, Jeffrey Tyler2, Alan Kwan2

  • 1Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.

Reviews in Cardiovascular Medicine
|July 25, 2020
PubMed

Insights

Thrombolysis may be insufficient for ST-elevation myocardial infarction (STEMI) in COVID-19 patients. Early invasive hemodynamics are crucial for managing distributive shock in these complex cases.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • ACC/SCAI guidelines recommend thrombolysis for COVID-19 patients with ST-elevation myocardial infarction (STEMI).
  • This case examines the management of a patient with concurrent COVID-19 and STEMI.

Observation:

  • The patient received initial treatment with thrombolysis and anticoagulation.
  • Persistent thrombus burden necessitated subsequent thrombectomy and stent placement.
  • Invasive hemodynamics revealed a high cardiac output state with low systemic vascular resistance, indicative of distributive shock.

Findings:

  • Thrombolytic therapy alone proved inadequate for this STEMI patient with COVID-19.
  • Early invasive hemodynamic assessment was vital for diagnosing distributive shock.
  • The patient's shock was characterized by high cardiac output and low systemic vascular resistance.

Implications:

  • Thrombolysis may not be sufficient as a sole reperfusion strategy for STEMI in COVID-19 patients.
  • Early invasive hemodynamic monitoring is essential for effective shock management in patients with STEMI and COVID-19.
  • This case highlights the complex interplay between COVID-19 infection and acute cardiovascular events.

Keywords:
COVID-19ST-elevation myocardial infarctionacute coronary syndromethrombolysis

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