RESUMEN
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the global coronavirus disease 2019 (COVID-19) pandemic. Although the virus predominantly causes respiratory system infection, recent reports have shown that it is also associated with many cardiovascular complications. It has been reported that COVID-19 may cause myocarditis, type 1 and 2 acute myocardial infarction, and thrombotic complications.[1] Spontaneous coronary artery dissection (SCAD) is a rare form of coronary artery disease that has recently been associated with COVID-19 in a few case reports. The case reported here is of COVID-19 associated SCAD in a patient with no history of cardiovascular disease.
Asunto(s)
COVID-19/complicaciones , Enfermedad de la Arteria Coronaria , Anomalías de los Vasos Coronarios , Enfermedades Vasculares/congénito , Enfermedad de la Arteria Coronaria/fisiopatología , Enfermedad de la Arteria Coronaria/terapia , Enfermedad de la Arteria Coronaria/virología , Anomalías de los Vasos Coronarios/fisiopatología , Anomalías de los Vasos Coronarios/terapia , Anomalías de los Vasos Coronarios/virología , Electrocardiografía , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Vasculares/fisiopatología , Enfermedades Vasculares/terapia , Enfermedades Vasculares/virologíaAsunto(s)
Anticuerpos Antivirales/sangre , COVID-19/complicaciones , Anomalías de los Vasos Coronarios/virología , SARS-CoV-2/inmunología , Enfermedades Vasculares/congénito , Angiografía Coronaria , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Anomalías de los Vasos Coronarios/tratamiento farmacológico , Electrocardiografía , Femenino , Humanos , Persona de Mediana Edad , Troponina T/sangre , Enfermedades Vasculares/diagnóstico por imagen , Enfermedades Vasculares/tratamiento farmacológico , Enfermedades Vasculares/virología , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Izquierda/tratamiento farmacológicoRESUMEN
A 48-year-old woman with a past medical history of migraines and hyperlipidemia presented due to severe retrosternal chest pain with no other associated signs or symptoms. The patient was hemodynamically stable and was found to have an elevated troponin with electrocardiogram showing no ischemic changes. Computed tomography of the coronary arteries showed a left dominant system with dissection extending from the mid-to-distal left anterior descending (LAD) artery. The patient was subsequently discharged on medical therapy but returned 3 days later due to worsening chest pain. Electrocardiogram revealed inferior and anteroseptal ST segment changes with peak troponin of 14.9 ng/ml (reference range <0.80 ng/ml). Coronavirus disease 2019 (COVID-19) nasopharyngeal swab was performed prior to urgent coronary angiogram. Coronary angiogram was performed with full personal protective equipment for respiratory and droplet precautions due to pending COVID-19 testing results. Angiogram revealed spontaneous coronary artery dissection (SCAD) extending from the ostium of the LAD to the distal vessel. COVID-19 testing returned positive while in intensive care unit. The patient was not a percutaneous coronary intervention candidate due to the extent of the dissection and was not a surgical candidate due to a lack of graftable target and medical management was continued. To our knowledge, this case is the first in which SCAD has been reported in the LAD in a patient with COVID-19 with no other symptoms of respiratory illness or symptoms classically associated with the novel coronavirus. SCAD should be considered on the differential as one of the various cardiac manifestations of COVID-19 infection.