MYOCARDIAL INFARCTION AFTER RECEIVING THE COVID-19 VACCINE IN A PATIENT WITH HIGH RISK FOR THROMBOSIS

Background:

Coronavirus disease 2019 (COVID-19) is known to cause and exacerbate some auto-inflammatory/auto-immune phenomenon. However, there is minimal data on the aggravation of these auto-immune diseases with the vaccine. We present a patient with antiphospholipid syndrome who rapidly declined after receiving the covid vaccine.

Case:

A 37-year-old male presented to the hospital with chest pain radiating to both shoulders, shortness of breath, and fevers. The symptoms were sudden in onset and started while the patient was taking a shower. He received his first dose of the COVID-19 vaccine the day before the onset of these symptoms. His medical history included antiphospholipid syndrome, Factor 5 Leiden, peripheral arterial disease, bilateral pulmonary embolism (PE), recurrent upper and lower extremity deep vein thrombosis (DVT), and chronic anticoagulation use. The patient has a history of 3 stents placed in his lower extremity and an IVC filter. He uses aspirin, clopidogrel, and rivaroxaban at home for his coagulopathy and claims to have missed his last two doses of clopidogrel. In the hospital, a CT angiogram confirmed the absence of a new PE. He presented with a troponin of 3.42 ng/mL, and the electrocardiogram (EKG) showed no acute ST-T changes. There was no prior history of any coronary artery disease.

Decision-making:

Serial Troponins and EKGs were ordered per ACS protocol. The anticoagulation was held, and the patient was placed on a heparin drip. As the troponin elevated to >50 ng/mL, the patient underwent a left heart catheterization (LHC) which showed a clot with 99% occlusion in the distal left circumflex artery with no significant disease in other vessels. The patient underwent a successful balloon angioplasty with a drug-eluting stent.

Conclusion:

Further studies and encouraged reporting from individuals receiving COVID-19 vaccines can help establish a more thorough side-effect profile and determine appropriate eligibility for the COVID-19 vaccines.