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A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
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Segmental Coronary Vasospasm Mimicking ST-Elevation Myocardial Infarction in an Incidentally COVID-Positive Patient

Muhammad Hamza Saad Shaukat1, Jeffrey Wilson1, Adam Stys1

  • 1Department of Cardiology, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota.

South Dakota Medicine : the Journal of the South Dakota State Medical Association
|August 27, 2021
PubMed

Insights

Coronary vasospasm, a cause of heart attacks without artery blockages, can be triggered by systemic inflammation. This case highlights COVID-19 as a potential trigger for focal coronary vasospasm.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Coronary vasospasm is an underdiagnosed cause of myocardial infarction (MI) in patients without obstructive coronary artery disease (CAD).
  • Systemic inflammation is a known trigger for coronary vasospasm.
  • Diverse clinical manifestations of COVID-19 continue to be reported.

Observation:

  • A 47-year-old woman, incidentally COVID-positive, presented with constitutional symptoms and breast cellulitis.
  • During hospitalization, she developed acute, typical angina at rest with inferolateral ST-elevation on EKG.
  • Coronary angiogram revealed focal, subtotal occlusions responsive to nitroglycerin in the right and circumflex coronary arteries.

Findings:

  • The patient experienced focal coronary artery spasm mimicking ST-elevation MI.
  • The vasospasm was successfully managed with intracoronary nitroglycerin.
  • COVID-19 infection was incidentally diagnosed during the evaluation.

Implications:

  • This case suggests COVID-19 may precipitate focal coronary vasospasm, contributing to its diverse clinical spectrum.
  • Focal coronary vasospasm, distinct from diffuse spasm, presents a diagnostic and mechanistic challenge.
  • Recognition of COVID-19-associated coronary vasospasm is crucial for timely diagnosis and management of MI in this population.

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