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Postoperative myocardial injury in a patient with left ureteric stone and asymptomatic COVID-19 disease
Nadeem Kassam1, Omar Aziz2, Ally Zain Ismail3
1Department of Internal medicine, Aga Khan University, Medical college, East Africa.
Insights
Asymptomatic COVID-19 can cause myocardial injury, even in patients undergoing surgery. This case underscores the need for thorough preoperative evaluation to identify and manage potential cardiac complications during the pandemic.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, is a global health emergency.
- COVID-19 presents with a spectrum of illness, from asymptomatic infection to severe pneumonia and ARDS.
- SARS-CoV-2 can lead to myocardial injury, indicated by ECG changes or elevated troponin levels, associated with poor outcomes.
Observation:
- A case report of a hypertensive male with undiagnosed, asymptomatic COVID-19 undergoing emergency urologic surgery for ureteric calculi.
- The patient developed postoperative myocardial injury, leading to a fatal outcome.
Findings:
- Undiagnosed, asymptomatic COVID-19 poses a significant risk for postoperative myocardial injury.
- Myocardial injury in COVID-19 patients, even those without symptoms, is linked to severe illness and mortality.
Implications:
- Highlights the critical importance of comprehensive preoperative assessment in the context of the COVID-19 pandemic.
- Emphasizes the need to anticipate and manage potential cardiac complications in surgical patients with undiagnosed SARS-CoV-2 infection.
- Underscores the potential for severe outcomes in patients with asymptomatic COVID-19 and myocardial involvement.
Abstract:
Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It was first identified on 8thDecember 2019 in Wuhan, Hubei, China, and has since spread globally to become an emergency of international concern. Patients infected with SARS-CoV-2 may be asymptomatic or present with symptoms ranging from mild clinical manifestations: such as fever, cough, and sore throat to moderate and severe form of the disease such as pneumonia and acute respiratory distress syndrome (ARDS). In some patients, SARS-CoV-2 can affect the heart and cause myocardial injury which is evidenced either by electrocardiographic (ECG) changes or by a rise in serum troponin level. Patients with myocardial involvement are generally at risk of developing severe illness and tend to have a poor outcome. We hereby present a case of a hypertensive male patient with undiagnosed, asymptomatic COVID-19, who underwent an emergency urologic procedure for ureteric calculi. He eventually sustained a postoperative myocardial injury resulting in his demise. This case highlights the importance of detailed preoperative assessment and anticipation of complications during this global pandemic.
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