SBV Journal of Basic, Clinical and Applied Health Science
Volume 6 | Issue 1 | Year 2023

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

Ankush Balasaheb Kolhe

Department of Medicine, Medicover Hospital, Aurangabad, Maharashtra, India

Corresponding Author: Ankush Balasaheb Kolhe, Department of Medicine, Medicover Hospital, Aurangabad, Maharashtra, India, Phone: +91 9975636094, e-mail:

How to cite this article: Kolhe AB. Acute Myocardial Infarction due to COVID-19 (Severe Acute Respiratory Syndrome Coronavirus-2) Infection: A Case Report. J Basic Clin Appl Health Sci 2023;6(1):12–15.

Source of support: Nil

Conflict of interest: None

Received on: 18 October 2022; Accepted on: 29 October 2022; Published on: 31 December 2022


Coronavirus disease-2019 (COVID-19) is known to cause pneumonia and adult respiratory distress syndrome (ARDS). It is found that it causes various microthrombosis and gives rise to vascular complications. To support this notion, we are presenting a case of acute myocardial infarction due to COVID-19 infection of a patient who does not have any symptoms of COVID-19 or coronary artery disease, ischemic heart disease, or any mico- or macrothrombosis in past.

A 60-year-old female patient presented to our hospital with complaints of chest pain radiating to the left shoulder and arm associated with sweating and palpitation. On detailed examination, her pulse rate was 100/minute, blood pressure (BP) was 140/90 mm Hg, her respiratory rate (RR) was 20/minute, and her oxygen saturation on her pulse oximeter is 98%. Electrocardiogram (ECG) done suggestive of acute myocardial infarction, that is, ST elevation in (V1–V4) precordial chest leads with reciprocal changes in limb leads. The patient is thrombosed with 15 lakhs units of streptokinase. She was started on heparin (unfractionated) infusion and loaded with antiplatelet drugs. Her X-ray chest showed features of COVID-19 pneumonitis. The patient’s high-resolution computed tomography (HRCT) of the chest showed a severity score of 3/25.

Keywords: Acute myocardial infarction, Coronavirus disease-2019, Ischemic heart disease.


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.810 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


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.

Table 1: Laboratory findings
COVID-19 profile Routine profile
Parameter Value Reference range Parameter Value Reference range
CPR 3.54 0.0–5.0 RBS 128 70–140
D-dimer 2.22 0.0–0.5 Sodium 136 135–138
Ferritin 36 23.3–336.2 Potassium 4.0 3.5–4.5
LDH 198 142–270 Urea 29 17–43
PT 13.8 11–16 Creatinine 1.0 0.72–1.18
INR 1.06 0.8–1.2 WBC 5900 4000–10000
IgM SARS-CoV-2 antibody Reactive 4.46 >1.0 for reactive HB 12.0 13–17
IgG SARS-CoV-2 antibody Reactive 56.08 >1.0 for reactive MCV 91.4 83–11
RTPCR true NAAT SARS-CoV-2 Negative E gene not detected or fia gene not detected Platelet 171000 150–410
HS Troponin I 20.8 Less than 17.9 pg/mL N 72 40–80
TSH 0.56 0.35–4.95 L 21 20-40
HIV Non-128 reactive   E 03 1.0–6.0
CRP, C-reactive protein; E, eosinophils; HB, hemoglobin; HBSAG, hepatitis B surface antigen; HCV, hepatitis C virus; HIV, human immunodeficiency virus; Hs troponin I, high sensitive troponin I test; IgM, immunoglobulin type M; INR, international normalized ratio; L, lymphocytes; LDH, lactate dehydrogenase; MCV, mean corpuscular volume; N, neutrophils; NAAT, nucleic acid amplification test; PT, prothrombin time; RBS, random blood sugar; RTPCR, real-time reverse transcriptase; ST, segment between S & T point in electrocardiogram; TSH, thyroid-stimulating hormone; WBC, white blood cell count

Fig. 1: The ECG findings

Fig. 2: The 2D echocardiography

Fig. 3: The X-ray chest


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


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.


Ankush Balasaheb Kolhe


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