Paciente de 30 años con infarto agudo al miocardio e infección por SARS-CoV-2, presentación inhabitual de Covid-19. Caso clínico

ABSTRACT

Isolated cardiac involvement of COVID-19 is an infrequent presentation, and myocardial infarction is even less common. We report a 30-year-old man presenting with retrosternal pain of insidious onset whose intensity increases suddenly. On admission, the patient had tachycardia and an EKG showed a 1 mm ST-elevation and diffuse PQ segment depression. Troponin was 26.9 ng/ml (normal value [NV] < 0.03), inflammatory parameters were elevated, and SARS-CoV 2 PCR was positive. He was hospitalized with the diagnosis of myopericarditis secondary to SARS-CoV 2. He progressed favorably without pain during the hospital stay and with decreasing troponin values. A Cardiac Magnetic Resonance Imaging (MRI) was compatible with an infero-lateral transmural infarction. A coronary angiography showed a distal occlusion of the circumflex artery. Consequently, anticoagulation and double platelet anti-aggregation were started. The patient evolved favorably, with a decreasing troponin curve (last at discharge 0.49 ng/ml) and a control EKG with pathological Q in DIII and AvF, and symmetrically inverted T in DII, DIII, AvF, V4, V5, and V6.