Inferior Wall Myocardial Infarction in Severe COVID-19 Infection: A Case Report

Am J Case Rep. 2020 Sep 28:21:e926101. doi: 10.12659/AJCR.926101.

Abstract

BACKGROUND The novel coronavirus disease (COVID-19) has been declared a pandemic. With the ever-increasing number of COVID-19 patients, it is imperative to explore the factors related to the disease to aid patient management until a definitive vaccine is ready, as the disease is not limited to the respiratory system alone. COVID-19 has been associated with various cardiovascular complications including acute myocardial injury, myocarditis, arrhythmias, and venous thromboembolism. The infection is severe in patients with pre-existing cardiovascular disease, and a systemic inflammatory response due to a cytokine storm in severe COVID-19 cases can lead to acute myocardial infarction. CASE REPORT We present the case of a 56-year-old man with cardiovascular risk factors including coronary artery disease, hypertension, ischemic cardiomyopathy, and hyperlipidemia, who had COVID-19-induced pneumonia complicated with acute respiratory distress syndrome. He subsequently developed myocardial infarction during his hospitalization at our facility. He had a significant contact history for COVID-19. He was managed with emergent cardiac revascularization after COVID-19 was confirmed by real-time reverse transcription-polymerase chain reaction testing from a nasopharyngeal swab as per hospital policy for admitted patients. Apart from dual antiplatelet therapy, tocilizumab therapy was initiated due to the high interleukin-6 levels. His hospitalization was complicated by hemodialysis and failed extubation and intubation, resulting in a tracheostomy. Upon improvement, he was discharged to a long-term facility with a plan for outpatient follow-up. CONCLUSIONS In high-risk patients with COVID-19-induced pneumonia and cardiovascular risk factors, a severe systemic inflammatory response can lead to atherosclerotic plaque rupture, which can manifest as acute coronary syndrome.

Publication types

  • Case Reports
  • Review

MeSH terms

  • COVID-19
  • COVID-19 Testing
  • Clinical Laboratory Techniques / methods
  • Coronary Angiography / methods
  • Coronavirus Infections / complications*
  • Coronavirus Infections / diagnosis
  • Critical Illness
  • Follow-Up Studies
  • Humans
  • Inferior Wall Myocardial Infarction / complications*
  • Inferior Wall Myocardial Infarction / diagnostic imaging
  • Inferior Wall Myocardial Infarction / therapy*
  • Long-Term Care / methods
  • Male
  • Middle Aged
  • Multimorbidity
  • Pandemics
  • Percutaneous Coronary Intervention / methods*
  • Pneumonia, Viral / complications*
  • Pneumonia, Viral / diagnosis
  • Respiration, Artificial / methods
  • Risk Assessment
  • Severe Acute Respiratory Syndrome / complications*
  • Severe Acute Respiratory Syndrome / diagnosis
  • Severe Acute Respiratory Syndrome / therapy
  • Time Factors
  • Tracheostomy / methods
  • Treatment Outcome