Apparently normal epicardial coronaries in a patient with inferior wall myocardial infraction on the background of mild coronavirus disease-2019: take a second look!

https://doi.org/10.4081/monaldi.2021.1668

Authors

  • Barun Kumar Department of Cardiology, All India Institute of Medical Sciences (AIIMS), Rishikesh, India.
  • Ashwin Kodliwadmath | ashrocks33@gmail.com Department of Cardiology, All India Institute of Medical Sciences (AIIMS), Rishikesh, India.
  • Amar Upadhyay Department of Pediatrics, Doon Medical College, Dehradun, India.
  • Anupam Singh Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Rishikesh, India.
  • Nanda N Department of Endocrinology, All India Institute of Medical Sciences (AIIMS), Rishikesh, India.

Abstract

The coronary angiographic (CAG) findings of ST elevation myocardial infarction (STEMI) in patients of coronavirus disease 2019 (COVID-19) range from increased coronary artery thrombus burden to normal coronaries due to STEMI mimics. Here we report the case of a 45-year-old gentleman who presented with evolved inferior wall myocardial infarction with ongoing angina along with mild COVID-19. CAG showed normal epicardial coronaries except for distal right posterior descending coronary artery (RPDA) 100% occlusion on careful examination. He was treated for the myocardial infarction with medical management along with treatment of COVID-19. The importance of our case is to highlight the possibility of distal total occlusion of small coronary branches which may be missed if not carefully looked for as a normal CAG in COVID-19 patient will require only supportive therapy, while the finding of distal 100% occlusion of RPDA deemed us to prescribe optimal medical therapy as per acute myocardial infarction protocol along with treatment for COVID-19.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

References

Ortega-Paz L, Capodanno D, Montalescot G, Angiolillo DJ. Coronavirus disease 2019-associated thrombosis and coagulopathy: review of the pathophysiological characteristics and implications for antithrombotic management. J Am Heart Assoc 2021;10:e019650. DOI: https://doi.org/10.1161/JAHA.120.019650

Roffi M, Guagliumi G, Ibanez B. The obstacle course of reperfusion for ST-segment–elevation myocardial infarction in the COVID-19 pandemic. Circulation 2020;141:1951–3. DOI: https://doi.org/10.1161/CIRCULATIONAHA.120.047523

Bennett CE, Anavekar NS, Gulati R, et al. ST-segment elevation, myocardial injury, and suspected or confirmed COVID-19 patients: diagnostic and treatment uncertainties. Mayo Clin Proc 2020;95:1107-11. DOI: https://doi.org/10.1016/j.mayocp.2020.04.005

Cizgici AY, Agus HZ, Yildiz M. COVID-19 myopericarditis: it should be kept in mind in today's conditions. Am J Emerg Med 2020;38:1547. DOI: https://doi.org/10.1016/j.ajem.2020.04.080

Rapkiewicz AV, Mai X, Carsons SE, et al. Megakaryocytes and platelet-fibrin thrombi characterize multi-organ thrombosis at autopsy in COVID-19: a case series. EClinicalMedicine 2020;24:100434. DOI: https://doi.org/10.1016/j.eclinm.2020.100434

Becker RC. COVID-19 update: COVID-19-associated coagulopathy. J Thromb Thrombols 2020;50:54–67. DOI: https://doi.org/10.1007/s11239-020-02134-3

Bilaloglu S, Aphinyanaphongs Y, Jones S, et al. Thrombosis in hospitalized patients with COVID-19 in a New York City health system. JAMA 2020;324:799–801. DOI: https://doi.org/10.1001/jama.2020.13372

Vidivich MI, Fischman DL, Bates ER. COVID-19 STEMI 2020 it’s not what you know, it’s how you think. JACC Case Rep 2020 27;2:1289-90. DOI: https://doi.org/10.1016/j.jaccas.2020.04.016

Tavazzi G, Pellegrini C, Maurelli M, et al. Myocardial localization of coronavirus in COVID-19 cardiogenic shock. Eur J Heart Fail 2020;22:911–5. DOI: https://doi.org/10.1002/ejhf.1828

Guzik TJ, Mohiddin SA, Dimarco A, et al. COVID-19 and the cardiovascular system: implications for risk assessment, diagnosis, and treatment options. Cardiovasc Res 2020;116:1666–87. DOI: https://doi.org/10.1093/cvr/cvaa106

Avila J, Long B, Holladay D, Gottlieb M. Thrombotic complications of COVID-19. Am J Emerg Med 2021;39:213-8. DOI: https://doi.org/10.1016/j.ajem.2020.09.065

Welt FGP, Shah PB, Aronow HD, et al. Catheterization laboratory considerations during the coronavirus (COVID-19) pandemic: from the ACC’s interventional council and SCAI. J Am Coll Cardiol 2020;75:2372–5. DOI: https://doi.org/10.1016/j.jacc.2020.03.021

Mahmud E, Dauerman HL, Welt FGP, et al. Management of acute myocardial infarction during the COVID-19 pandemic: a position statement from the society for cardiovascular angiography and interventions (SCAI), the American college of cardiology (ACC), and the American college of emergency physicians (ACEP). J Am Coll Cardiol 2020;76:1375-84. DOI: https://doi.org/10.1016/j.jacc.2020.04.039

Published
2021-04-06
Info
Issue
Section
Cardiology - Case Reports
Keywords:
COVID-19, ST elevation myocardial infarction, coronary angiography, thrombosis
Statistics
  • Abstract views: 121

  • PDF: 58
  • VIDEO 1: 8
  • VIDEO 2: 2
How to Cite
Kumar, Barun, Ashwin Kodliwadmath, Amar Upadhyay, Anupam Singh, and Nanda N. 2021. “Apparently Normal Epicardial Coronaries in a Patient With Inferior Wall Myocardial Infraction on the Background of Mild Coronavirus Disease-2019: Take a Second Look!”. Monaldi Archives for Chest Disease, April. https://doi.org/10.4081/monaldi.2021.1668.