Myocardial infarction with nonobstructive coronary arteries (MINOCA) in COVID-19 infection: A case report

Myocardial Infarction with nonobstructive coronary arteries (MINOCA) by definition is having stenosis of less than 50% or no stenosis in coronary angiography in a patient who has been diagnosed with Myocardial Infarction. Inflammation, hypoxia, and thrombotic environment found in COVID-19 infection predispose patient to get MINOCA. The incidence of MINOCA in patients with COVID-19 infection is more well known now. Here is a case report of a 47-year-old gentleman who was diagnosed with MINOCA syndrome, clinically showed STEMI, and received thrombolysis, however coronary angiography showed no stenosis during hospitalization for COVID-19 infection. He was presented on day 6 of illness which he desaturated upon presentation after home quarantine. His CT Pulmonary Angiography showed no evidence of pulmonary embolism. He was started with dexamethasone and tocilizumab subsequently. On day 16 of illness, he complained of left-sided chest pain with vitals sign showed BP 117/74 mmHg, HR 77, oxygen saturation 91–92% under venti mask 40% 12 L/min, and clinically no evidence of fluid overload. ECG showed sinus rhythm, deep Q V2-V3, ST elevation V2-V5, 3 mm @ V3 at 6H after chest pain, and Troponin I was 48. IV thrombolysis with streptokinase given as treated for acute ST-elevation MI followed by dual antiplatelet. ECG post thrombolysis showed persistent ST elevation, but angina resolved completely, and no complication developed after that. Subsequently, he completed subcutaneous fondaparinux for 5 days. Angiogram was done on day 21 of the illness and the findings were normal coronary artery vessels. He was discharged well. MINOCA syndrome associated with COVID 19 infection needs further evaluation and clinical trial in future as the it is more common at present.