Background
Cardiac complications in the setting of COVID-19 are well recognised; however, reports of vasospasm are rare. We present a case of life-threatening coronary vasospasm in the setting of infection with the Omicron BA.1 variant of SARS-CoV-2.
Case Presentation
In December 2021 during the Omicron surge in Sydney, NSW, a 51-year-old male presented with recurrent central chest pain over the preceding 12 hours. He had a 2-day history of a non-productive cough and fevers but no known COVID exposures. His past medical history included hypercholesterolaemia, but no risk factors for severe COVID disease. A further episode of chest pain in the emergency department was associated with bradycardia (HR 40 bpm) and hypotension (SBP 70 mmHg). Electrocardiograms demonstrated junctional bradycardia with 3 mm of inferior ST-segment elevation. Emergent coronary angiography revealed moderate diffuse left coronary obstruction and critical diffuse right coronary obstruction. The angiographic (and ECG) changes resolved completely with administration of intracoronary glyceryl trinitrate, indicative of vasospasm. Admission rapid nasopharyngeal PCR returned positive for SARS-CoV-2 and subsequent whole genome sequencing confirmed the Omicron BA.1 variant. Nifedipine was commenced, and he had no further events during a 3-day admission. Serial troponin T and transthoracic echocardiogram were normal. COVID-specific therapy was not required. He remained asymptomatic at follow-up and CTCA 1 month later confirmed normal coronary arteries with a coronary calcium score of zero.
Discussion
Coronary vasospasm in the setting of COVID-19 has been rarely reported. Life-threatening coronary spasm may be an under-recognised entity, potentially responsible for sudden death in patients with otherwise less severe COVID.
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