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Published on: June 11, 2020
[COVID-19 infection presenting as a myocardial infarction. Report of one case]
Sebastián Weitz-Muñoz1, Alfredo Parra-Lucares1, Fernando Ihl1
1Hospital Clínico, Universidad de Chile, Santiago, Chile.
Insights
This case study highlights a rare instance of COVID-19 causing myocardial infarction (heart attack) in a young man. Prompt diagnosis and treatment led to a favorable outcome, emphasizing the diverse cardiac manifestations of SARS-CoV-2 infection.
Area of Science:
- Cardiology
- Infectious Diseases
- Internal Medicine
Background:
- Isolated cardiac involvement in COVID-19 is uncommon.
- Myocardial infarction (MI) as a direct result of SARS-CoV-2 infection is even rarer.
- This case presents a unique manifestation of COVID-19 affecting the heart.
Observation:
- A 30-year-old male presented with acute chest pain, tachycardia, EKG changes (ST-elevation, PQ depression), and elevated troponin levels.
- SARS-CoV-2 PCR was positive, leading to a diagnosis of myopericarditis secondary to COVID-19.
Findings:
- Cardiac MRI confirmed infero-lateral transmural infarction.
- Coronary angiography revealed distal occlusion of the circumflex artery.
- The patient showed clinical improvement with decreasing troponin levels and characteristic EKG changes post-treatment.
Implications:
- This case underscores the potential for SARS-CoV-2 to cause significant cardiac events like myocardial infarction, even in young individuals.
- Early diagnosis and management, including anticoagulation and antiplatelet therapy, are crucial for favorable outcomes in COVID-19-associated cardiac complications.
Abstract:
Isolated cardiac involvement of COVID-19 is an infrequent presentation, and myocardial infarction is even less common. We report a 30-year-old man presenting with retrosternal pain of insidious onset whose intensity increases suddenly. On admission, the patient had tachycardia and an EKG showed a 1 mm ST-elevation and diffuse PQ segment depression. Troponin was 26.9 ng/ml (normal value [NV] < 0.03), inflammatory parameters were elevated, and SARS-CoV 2 PCR was positive. He was hospitalized with the diagnosis of myopericarditis secondary to SARS-CoV 2. He progressed favorably without pain during the hospital stay and with decreasing troponin values. A Cardiac Magnetic Resonance Imaging (MRI) was compatible with an infero-lateral transmural infarction. A coronary angiography showed a distal occlusion of the circumflex artery. Consequently, anticoagulation and double platelet anti-aggregation were started. The patient evolved favorably, with a decreasing troponin curve (last at discharge 0.49 ng/ml) and a control EKG with pathological Q in DIII and AvF, and symmetrically inverted T in DII, DIII, AvF, V4, V5, and V6.
