Coronavirus Disease 2019 (COVID-19) Manifestation as Acute Myocardial Infarction in a Young, Healthy Male

Abstract

Although a large part of the symptomology of coronavirus disease 2019 (COVID-19) has been attributed to its effects in the lungs, the virus has also been shown to cause extensive cardiovascular complications in a small subset of patients. In this case report, we describe a 29-year-old nonobese hospital food service associate who presented with diffuse abdominal and chest pain; he was found to be positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with significantly elevated levels of troponin T and multiple acute phase reactants; his EKG demonstrated ST-elevations consistent with anterolateral infarction. Despite having no significant past medical history or atherosclerotic risk factors, he was found to have a complete occlusion of his left anterior descending artery that required cardiac catheterization. This case demonstrates that cardiovascular complications must be considered in the COVID-19 population, even without the clear presence of other risk factors for heart disease.

Figure 1

The patient's EKG on admission, which demonstrates sinus rhythm with nonspecific ST changes in the lateral leads alongside T-wave inversions in lead III. There were no observed ST-segment elevations or ST-segment depressions.

Figure 2

The patient's chest X-ray: (a) PA and (b) lateral. The lungs demonstrated no focal consolidation to suggest pneumonia and no evidence of pulmonary edema, pleural effusion, or pneumothorax. The cardiac silhouette was noted to be within normal limits, and no free air was detected below the diaphragms.

Figure 3

The patient's EKG on the morning of day 2. There were ST elevations in lead I, aVL, and the precordial leads overlying the anterior and lateral surfaces of the heart (V3–V6), which was consistent with anterolateral infarction. These findings were not present on admission (Figure 1).

Figure 4

The patient's LAD thrombus (black arrow) (a) before and (b) after catheterization. Diagnostic angiography done prior to catheterization demonstrated complete midsegment occlusion of the LAD with no significant disease noted in the left main circumflex artery and the right coronary artery.