Subject(s)
COVID-19 Vaccines/adverse effects , COVID-19/prevention & control , Myocarditis , SARS-CoV-2/metabolism , Vaccination/adverse effects , 2019-nCoV Vaccine mRNA-1273 , Adult , COVID-19/blood , COVID-19/diagnostic imaging , COVID-19/epidemiology , COVID-19 Vaccines/administration & dosage , Humans , Male , Myocarditis/blood , Myocarditis/chemically induced , Myocarditis/diagnostic imaging , Myocarditis/physiopathologyABSTRACT
COVID-19 has varied cardiovascular manifestations including microvascular and macrovascular thrombi leading to multiorgan system injury and failure. This case describes a patient presenting with acute hypoxaemic respiratory failure from COVID-19 who abruptly developed a large thrombus in the right coronary artery leading to myocardial infarction. This case report reviews the ECG, heart catheterisation images prepercutaneous and postpercutaneous coronary intervention, critical care management and outcome in the context of the height of the COVID-19 pandemic in the Virginia area. A brief review of relevant literature regarding cardiovascular complications of COVID-19 is also provided. Unfortunately, the patient ultimately passed after 2 weeks of inability to wean off the ventilator.
Subject(s)
COVID-19/complications , Coronary Thrombosis/etiology , ST Elevation Myocardial Infarction/etiology , Angiography , COVID-19/diagnostic imaging , Cardiac Catheterization , Coronary Thrombosis/diagnostic imaging , Coronary Thrombosis/surgery , Diagnosis, Differential , Drug-Eluting Stents , Electrocardiography , Humans , Lung/diagnostic imaging , Male , Middle Aged , Pandemics , Radiography , SARS-CoV-2 , ST Elevation Myocardial Infarction/diagnostic imaging , ST Elevation Myocardial Infarction/surgery , ThrombectomyABSTRACT
The COVID 19 pandemic resulted in a total reduction in the number of hospitalizations for acute coronary syndromes. A consequence of the delay in coronary revascularization has been the resurgence of structural complications of myocardial infarctions. Ventricular septal rupture (VSR) complicating late presenting acute myocardial infarction (AMI) is associated with high mortality despite advances in both surgical repair and perioperative management. Current data suggests a declining mortality with delay in VSR repair; however, these patients may develop cardiogenic shock while waiting for surgery. Available options are limited for patients with VSR who develop right ventricular failure and cardiogenic shock. The survival rate is very low in patients with cardiogenic shock undergoing surgical or percutaneous VSR repair. In this study we present two late presenting ST elevation MI patients who were complicated by rapidly declining hemodynamics and impending organ failure. Both patients were bridged with venoarterial extracorporeal membrane oxygenation (ECMO) to cardiac transplant.
Subject(s)
COVID-19 , ST Elevation Myocardial Infarction , Ventricular Septal Rupture , Humans , Pandemics , SARS-CoV-2 , ST Elevation Myocardial Infarction/complications , ST Elevation Myocardial Infarction/surgery , Shock, Cardiogenic/etiology , Treatment Outcome , Ventricular Septal Rupture/diagnosis , Ventricular Septal Rupture/epidemiology , Ventricular Septal Rupture/etiologyABSTRACT
Although respiratory symptoms are the dominant features of COVID-19 infection, myocardial injury has been described in these patients. Reported cardiac manifestations of COVID-19 infection include myocarditis, arrhythmia and acute coronary syndrome including ST elevation myocardial infarction (STEMI). STEMI is a medical emergency and timely intervention is of utmost importance to prevent mortality and long-term morbidities. In this report, we present a wide spectrum of clinical presentations, management, and outcomes for five patients with COVID-19 infection and ST elevation on ECG.