Myocardial infarction with non-obstructive coronary artery in a middle-aged woman with COVID-19

Area of Science:

• Cardiology
• Infectious Diseases
• Critical Care Medicine

Background:

• Cardiovascular involvement is a known complication of coronavirus disease 2019 (COVID-19).
• COVID-19 can precipitate de novo cardiac conditions such as myocarditis and myocardial infarction.
• The pandemic led to reduced admissions for acute coronary syndromes due to patient reluctance to seek care.

Observation:

• A 47-year-old woman presented with acute heart failure and COVID-19 pneumonia.
• She reported chest pain two weeks prior but had no traditional coronary risk factors.
• Electrocardiogram suggested late-presenting myocardial infarction, and echocardiography revealed severe left ventricular systolic dysfunction.

Findings:

• Coronary angiography revealed no significant flow-limiting lesions.
• Cardiac magnetic resonance imaging demonstrated subendocardial enhancement in the left anterior descending artery territory.
• These findings were compatible with myocardial infarction.

Implications:

• This case illustrates that COVID-19 can cause myocardial infarction even in individuals without pre-existing cardiovascular risk factors.
• It emphasizes the importance of considering cardiac complications in COVID-19 patients presenting with heart failure symptoms.
• Prompt diagnosis and management are crucial for improving outcomes in these patients.