Delayed presentation of acute coronary syndrome with mechanical complication during COVID-19 pandemic: a case report
Joo Hor Tan1, Jieli Tong1, Hee Hwa Ho1
1Department of Cardiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng Hospital, Singapore 308433, Singapore.
Insights
Fear of COVID-19 led to delayed medical care for a patient experiencing acute myocardial infarction (AMI). This delay resulted in a rare complication, cardiac tamponade, highlighting the pandemic's impact on health-seeking behaviors.
Area of Science:
- Cardiology
- Public Health
Background:
- The COVID-19 pandemic significantly altered patient behavior, leading to delayed medical consultations.
- Fear of contracting COVID-19 discouraged patients from seeking timely care for critical conditions.
Purpose of the Study:
- To report a case of acute myocardial infarction (AMI) with a rare complication due to delayed presentation.
- To illustrate the impact of pandemic-related fears on patient health-seeking behavior and medical intervention.
Main Methods:
- A 65-year-old male with hypertension presented late with symptoms of AMI.
- Diagnostic workup included ECG, chest radiograph, echocardiogram, CT aortogram, and coronary angiogram.
- The patient underwent emergency surgical repair for a contained left ventricular wall rupture and cardiac tamponade.
Main Results:
- The patient presented with ST-elevation myocardial infarction after a 4-hour delay due to COVID-19 fears.
- Investigations revealed cardiac tamponade and a contained left ventricular wall rupture.
- Successful emergency surgical repair was performed at a tertiary center.
Conclusions:
- Delayed medical intervention due to pandemic fears can lead to severe, rare complications like cardiac tamponade in AMI patients.
- Physicians must recognize this trend and actively engage in public health education to encourage timely medical care seeking.
Background:
The World Health Organization declared coronavirus disease 2019 (COVID-19) a global pandemic on 11 March 2020. We report a patient with acute myocardial infarction (AMI) who presented late due to fears of contracting COVID-19.
Case Summary:
A 65-year-old man with a history of hypertension presented late to the emergency department (ED) with AMI. He gave a 2-month history of exertional angina but avoided seeking medical consult due to fears of contracting COVID-19. On the day of admission, he had 4 h of severe chest pain before presenting to the ED. He was hypotensive and tachycardic on arrival. Electrocardiogram showed inferolateral ST-elevation myocardial infarction. Chest radiograph revealed widened superior mediastinum and bedside echocardiogram revealed inferoseptal and inferolateral hypokinesia with features of cardiac tamponade. An urgent computed tomography aortogram showed possible left ventricular (LV) wall perforation with resulting haemopericardium and cardiac tamponade. Subsequent coronary angiogram showed 100% occlusion of mid left circumflex artery and a contained LV wall rupture was confirmed with LV ventriculogram. He was transferred to a tertiary centre and underwent successful emergency surgical repair.
Discussion:
Our index case demonstrates the impact of the COVID-19 pandemic on health seeking behaviour due to fears of contracting COVID-19 and the ensuing impact of delayed medical intervention. Cardiologists worldwide are seeing an alarming rate of rare complications of AMI in patients who present late. Physicians need to be aware of this phenomenon and have an active role to play in public education.
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