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. 2021 Jun 26;5(6):ytab218. doi: 10.1093/ehjcr/ytab218
Timeline Course of events
3 days prior to admission Typical angina chest pain associated with a dyspnoea Class II of the New York Heart Association
20 h prior to admission Left hemiplegia and confusion
Day 0

No chest pain on admission, stable haemodynamical status, polypnoea, SaO2 = 93% on room air, left hemi pyramidal syndrome

Cerebral computed tomography (CT) scan: mid-cerebral artery ischaemic stroke

Electrocardiogram (ECG): sinus rhythm, second-degree Mobitz 1 atrioventricular block, inferior STEMI

High troponin levels, inflammatory syndrome

Trans-thoracic echocardiogram: inferior and inferolateral wall motion abnormalities, no intracavitary thrombus, normal left ventricular ejection fraction

Contrast chest CT scan: no aortic dissection, bilateral pulmonary embolism, bilateral lung condensation, and ground-glass opacities (COVID-19 Reporting and Data System 3)

Supra-aortic vessel ultrasound: no plaques or stenosis

Day 1

24 h Holter ECG: sinus rhythm, no rhythm nor conduction abnormalities

Result of reverse transcription-polymerase chain reaction (RT-PCR) COVID 19 nasal swab negative, positive SARS-COV2 IgG antibodies, negative IgM antibodies

Day 2 Second RT-PCR COVID-19 swab negative
Day 3

Immunological tests for autoimmune diseases: negative

Thrombophilic tests: negative

Tumoral markers: negative

Antiphospholipid antibodies: negative

Doppler of temporal arteries: normal

Day 5 Thoraco-Abdomino-Pelvic CT scan: not remarkable for any tumour, regression of the lung lesions
Day 13 Transoesophageal echocardiography: no patent foramen oval, no left appendage thrombus
Day 14

Coronary angiography: tight stenosis spreads from the proximal right coronary artery (RCA) to the middle RCA

Neurological re-assessment → started on optimal doses of enoxaparin

Day 18 Discharge from hospital