Acute Coronary Syndrome in the COVID-19 Era-Differences and Dilemmas Compared to the Pre-COVID-19 Era
Ratko Lasica1, Lazar Djukanovic1, Igor Mrdovic1
1Department of Cardiology, Emergency Center, Clinical Center of Serbia, 11000 Belgrade, Serbia.
Insights
COVID-19 often impacts the heart, causing myocardial injury and acute coronary syndrome (ACS). Diagnosing and treating these co-occurring conditions presents significant challenges for physicians, increasing patient mortality.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- The COVID-19 pandemic, primarily a respiratory illness, is increasingly linked to cardiovascular complications.
- Cardiovascular disease (CVD) affects 10-30% of COVID-19 patients, with myocardial injury occurring in 7-36%.
- Acute coronary syndrome (ACS) incidence rises in COVID-19 due to thrombosis and myocardial oxygen demand-supply imbalance.
Purpose of the Study:
- To highlight the diagnostic and therapeutic challenges of managing patients with concurrent COVID-19 and acute myocardial infarction (AMI).
- To discuss the complexities arising from mixed symptoms, non-specific ECG changes, and elevated cardiac biomarkers.
- To analyze the benefit/risk ratio in treatment decisions for AMI patients with COVID-19, considering high ischemic and bleeding risks.
Main Methods:
- Review of current evidence on the intersection of COVID-19 and acute myocardial infarction.
- Analysis of diagnostic dilemmas including symptom overlap and biomarker interpretation.
- Evaluation of treatment strategies considering patient-specific risks.
Main Results:
- Diagnosis of ACS in COVID-19 patients is complicated by non-specific symptoms and ECG findings.
- Elevated serum troponin (cTn) levels present diagnostic challenges.
- Treatment decisions are complex due to balancing ischemic and bleeding risks.
Conclusions:
- Managing patients with both COVID-19 and AMI requires careful consideration of multiple clinical factors.
- Delayed treatment initiation in these complex cases leads to increased AMI complications and mortality.
- Further research is needed to optimize diagnostic and therapeutic protocols for this high-risk patient group.
Abstract:
The COVID-19 pandemic has led to numerous negative implications for all aspects of society. Although COVID-19 is a predominant lung disease, in 10-30% of cases, it is associated with cardiovascular disease (CVD). The presence of myocardial injury in COVID-19 patients occurs with a frequency between 7-36%. There is growing evidence of the incidence of acute coronary syndrome (ACS) in COVID-19, both due to coronary artery thrombosis and insufficient oxygen supply to the myocardium in conditions of an increased need. The diagnosis and treatment of patients with COVID-19 and acute myocardial infarction (AMI) is a major challenge for physicians. Often the presence of mixed symptoms, due to the combined presence of COVID-19 and ACS, as well as possible other diseases, nonspecific changes in the electrocardiogram (ECG), and often elevated serum troponin (cTn), create dilemmas in diagnosing ACS in COVID-19. Given the often-high ischemic risk, as well as the risk of bleeding, in these patients and analyzing the benefit/risk ratio, the treatment of patients with AMI and COVID-19 is often associated with dilemmas and difficult decisions. Due to delays in the application of the therapeutic regimen, complications of AMI are more common, and the mortality rate is higher.
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