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Unexpected sudden death on arrival in a healthy middle-aged man associated with COVID-19-related diffuse cardiac

Shotaro Isozaki1, Yu Kakimoto1, Haruka Ikeda1

  • 1Department of Forensic Medicine, Tokai University School of Medicine, Isehara 259-1193, Japan.

Heliyon
|January 3, 2024
PubMed

Insights

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause sudden cardiac death in healthy individuals. This occurs through microcirculatory disturbances leading to diffuse cardiac necrosis, driven by platelet activation.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Pathology

Background:

  • Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, is known to cause acute cardiac injury.
  • The precise mechanisms underlying COVID-19-associated cardiac injury remain poorly understood and distinct from other viral etiologies.

Observation:

  • A case of sudden death in a previously healthy 47-year-old male is presented.
  • The patient exhibited symptoms of malaise and fatigue, progressing to cardiac arrest, with a positive SARS-CoV-2 antigen test.
  • Autopsy revealed diffuse cardiac necrosis and microvascular platelet aggregation.

Findings:

  • COVID-19 infection was associated with diffuse cardiac necrosis in the absence of respiratory symptoms.
  • Platelet aggregation in cardiac microvessels suggests a mechanism of microcirculatory disturbance.
  • This pathway highlights a unique mechanism of severe cardiac injury in COVID-19 patients.

Implications:

  • COVID-19 can lead to fatal cardiac events in healthy individuals through a novel mechanism.
  • Platelet activation and subsequent microcirculatory disturbance represent a potential therapeutic target for managing COVID-19-related cardiac complications.

Keywords:
Myocardial injuryPlatelet aggregationSARS-CoV-2Sudden Unexpected death

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