Background:
COVID-19 has a wide range of manifestations, from asymptomatic to organ dysfunction and death. Similarly, the spectrum of thromboembolic events varies. We describe a patient with COVID-19-induced microvascular thrombosis leading to myocardial infarction (MI).
Case:
A 70-year-old male with a history of hypertension and dyslipidemia presented with retrosternal exertional chest pain radiating to his left arm. Vitals were stable and physical exam was unremarkable. ECG showed ST-T wave changes of ischemia. Cardiac troponin was elevated. Echocardiography revealed an ejection fraction of 55% with regional wall motion abnormalities. Patient underwent coronary angiography which revealed normal coronaries with an incidental anomalous origin of the left circumflex (LCx) coronary artery (Figure 1). Later on, he tested positive for COVID-19 which increases the suspicion of myocarditis, hence cardiac MRI was obtained which unexpectedly showed MI with subendocardial gadolinium enhancement rather than myocarditis (Figure 2).
Decision-making:
Thrombosis is a known complication of COVID-19 due to endothelial injury and hypercoagulability. Venous, arterial, and microvascular thrombosis have been reported. Our patient likely had areas of small intra-arterial microvascular thrombosis leading to MI.
Conclusion:
Physicians should have a high suspicion for MI in patients with COVID-19 who present with typical chest pain, even in the absence of coronary occlusion on angiogram.
Footnotes
Poster Contributions
For exact presentation time, refer to the online ACC.22 Program Planner at https://www.abstractsonline.com/pp8/#!/10461
Session Title: Complex Clinical Cases: FIT Flatboard Poster Selections – Covid
Abstract Category: FIT: Coronavirus Disease (COVID-19)