ST Elevation in the COVID-19 Era: A Diagnostic Challenge

Area of Science:

• Cardiology
• Infectious Diseases
• Emergency Medicine

Background:

• Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with a prothrombotic state.
• This can manifest as ST-elevation myocardial infarction (STEMI), a critical cardiac event.
• Diagnostic uncertainty regarding acute coronary occlusion in STEMI cases during COVID-19 requires careful consideration.

Observation:

• Two cases of COVID-19 patients presenting with STEMI on electrocardiogram (ECG) are presented.
• Both patients underwent cardiac catheterization for diagnosis and treatment.
• One patient experienced a delay in intervention, potentially impacting their outcome.

Findings:

• STEMI on ECG in COVID-19 patients does not always confirm acute coronary artery occlusion.
• Timely cardiac catheterization and intervention are vital for managing STEMI in this population.
• Prompt percutaneous coronary intervention is recommended during the SARS-CoV-2 pandemic.

Implications:

• Emergency physicians must maintain a high index of suspicion for cardiac emergencies in COVID-19 patients.
• Diagnostic delays for STEMI in COVID-19 patients can lead to adverse outcomes.
• Urgent cardiac catheterization should not be postponed in suspected STEMI cases during the pandemic.