Discharge after anterior myocardial infarction treated with percutaneous coronary angioplasty on left anterior descending artery (LAD)	Complained of fatigue, dyspnoea, hypotension. Refused access to emergency room (ER) because of fear of contracting COVID-19. Down-titration of medical therapy
Access to the ER following syncope	Evidence of interstitial pneumonia on computed tomography scan. Rapid evolution of Cardiogenic Shock with need for intra-aortic balloon pump (IABP) implant, high-dose inotropes.
Twelve hours later—nose-swab tested negative for COVID-19	Access to ‘clean’ intensive care unit (ICU), evidence of left ventricular (LV) aneurysm and dysfunction, mitral regurgitation, pulmonary congestion, and hypertension, sustained ventricular arrhythmias. Heart Team: decision to implant Impella 5.0 before cardiac surgery of ventriculoplasty and mitral valve repair.
Forty-eight hours after Impella 5.0 support	Reduction in pulmonary congestion, mitral regurgitation, LV filling pressures, termination of arrhythmias. Cardiac surgery with Impella 5.0 support during surgery and weaning off by-pass with minimal inotropic support.
Postoperative Day 5	Weaning off Impella 5.0 with aid of IABP.