COVID-19-convalescence phase unmasks a silent myocardial infarction due to coronary plaque rupture

Area of Science:

• Cardiology
• Infectious Diseases
• Pathophysiology

Background:

• COVID-19 infection is increasingly linked to cardiovascular complications such as myocarditis, arrhythmias, and myocardial infarctions (MIs).
• Mechanisms include direct viral injury, thrombosis, and inflammation, with inflammatory plaque instability and rupture implicated in post-COVID-19 MIs.

Observation:

• A case report details a patient in the COVID-19 convalescence phase experiencing temporary impairment of left ventricular ejection fraction (LVEF).
• This impairment unmasked a silent myocardial infarction (MI) that was diagnosed using invasive (Optical Coherence Tomography - OCT) and non-invasive (Cardiovascular Magnetic Resonance - CMR) imaging.

Findings:

• The study highlights the first documented instance of temporary LVEF impairment unmasking a silent MI due to coronary plaque rupture in the post-COVID-19 phase.
• Coronary plaque rupture was identified as the cause of the myocardial infarction.

Implications:

• Myocardial infarction should be considered in deteriorating COVID-19 patients, particularly those with persistent dyspnea after acute infection.
• This case underscores the importance of comprehensive cardiovascular assessment in post-COVID-19 patients, even in the absence of typical angina symptoms.