Fig. 4.
Coronary angiogram and CMR in a 69-year-old man who presented with anterior ST-elevation myocardial infarction (STEMI) in the context of COVID-19. CMR performed 25 days after the acute coronary syndrome. (A) Coronary angiogram showing proximal occlusion (arrow) of left anterior descending (LAD) artery with high burden of thrombus. (B) CMR axial Half-Fourier Acquisition Single-shot Turbo Spin Echo (HASTE) showing patchy bilateral lung changes of high signal in keeping with COVID-19. (C, D) Steady-state free precession (SSFP) MRI cine in endsystole showing thinning and akinesia of mid to apical septal walls extending to apical lateral walls and apical cap. (E, F) Late gadolinium enhancement (LGE) imaging showing transmural LGE in the mid to apical septal walls extending to the apical lateral walls and apical cap (blue arrows). In addition, there is partial extension of enhancement into the basal septal segments with evidence of microvascular obstruction in the basal anteroseptum (yellow arrow).