Acute Myocardial Infarction due to COVID-19 (Severe Acute Respiratory Syndrome Coronavirus-2) Infection: A Case Report

INTRODUCTION

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is an enveloped, non-segmented positive-sense ribonucleic acid (RNA) virus belonging to the β-coronaviridae family. This virus is known to cause severe bilateral pneumonia and ARDS.¹ The COVID-19 infection is known to develop a prothrombotic state, leading to microthrombosis.^2,3

Acute coronary syndrome (ACS) is a term used to describe a range of pathological conditions associated with sudden or reduced blood flow to the heart, which includes acute myocardial ischemia or ST-elevation myocardial infarction (STEMI), unstable angina, non-ST elevation myocardial infarction (NSTEMI).^4,5 Troponin I and Troponin T are the components of myocardial cells. They are used as a biomarker for the evaluation of myocardial injury.^5,6

Myocardial infarction and ACS found in COVID-19-affected patients in Italy were 2.5%.⁷ Furthermore, SARS-CoV-2 infects the reticuloendothelial cell and causes cellular damage, and induces inflammation and apoptosis.^8–10 We report a case of a SARS-CoV-2 infected patient who developed acute myocardial infarction without any past known history of coronary artery disease.¹¹

CASE DESCRIPTION

A 60-year-old female patient came with a history of left-sided chest pain progressing to the left shoulder and left arm, associated with palpitation and sweating. She did not have any history of fever, chills, body aches, cough, or any classical symptoms of COVID-19 infection. She was healthy and fine before hospitalization. She did not have a past history of coronary artery disease, ischemic heart disease, diabetes mellitus, hypertension, or any addictions. Her family members also did not have COVID-19 symptoms. On examination, her BP was found to be 140/90 mm Hg, her pulse rate was 110 beats/minute, and her RR was 20/minute.

Her saturation on pulse oximetry was 98% and her temperature was 98.1°F. She was thrombosed with 15 lakhs units of streptokinase. Intravenous heparin infusion started and started on oral antiplatelet and statin after loading dose. An ECG report shows acute myocardial infarction (Fig. 1). The 2D echocardiography was also performed (Fig. 2). The X-ray chest shows features suggestive of COVID-19 pneumonitis (Fig. 3). Laboratory findings showed elevated cardiac biomarkers; troponin was shown to be 20.8 pg/mL (Table 1). The HRCT chest examination was done which showed a computed tomography severity score (CT-SS) of 3/25.

DISCUSSION

The SARS-CoV-2 infection is mostly associated with respiratory system involvement but other presentations are also possible.^5,6 Here, we present a case to support this notion where the patient presented with acute myocardial infarction without respiratory signs and symptoms.⁵

She was a 60-year-old female who came with a history of left-sided chest pain radiating to her left shoulder and left arm and sweating. The patient had no past history of coronary artery disease. She had acute ST elevation myocardial infarction which was presumed to be due to the positive COVID-19 status. The COVID-19 infection causes an imbalance in the pro- and antithrombotic states of the body which predisposes to arterial thrombosis.^2,5

Cardiac involvement can be due to direct viral injury of the myocardium or due to systemic inflammation.^3,5 She was discharged on the seventh day with oral antiplatelet, β-blocker and statin. The doctor must be aware that the cardiovascular complications can occur in the COVID-19 patients without respiratory involvement.^2,4,5

CONCLUSION

The SARS-CoV-2 infection can lead to microthrombosis.^1,2,5 The COVID-19 infection can cause acute myocardial infarction. Patients of COVID-19 infection can present with other complications. Variable presentation of COVID-19 is possible.

ORCID

Ankush Balasaheb Kolhe https://orcid.org/0000-0002-8698-2548

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