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Case Reports
. 2020 Aug;2(10):1620-1624.
doi: 10.1016/j.jaccas.2020.04.010. Epub 2020 Apr 23.

Collateral Damage: Medical Care Avoidance Behavior Among Patients With Myocardial Infarction During the COVID-19 Pandemic

Francesco Moroni  1 , Mario Gramegna  2 , Silvia Ajello  3 , Alessandro Beneduce  1 , Luca Baldetti  2 , Luz Maria Vilca  4 , Alberto Cappelletti  2 , Anna Mara Scandroglio  3 , Lorenzo Azzalini  5
Affiliations
Case Reports

Collateral Damage: Medical Care Avoidance Behavior Among Patients With Myocardial Infarction During the COVID-19 Pandemic

Francesco Moroni et al. JACC Case Rep. 2020 Aug.

Abstract

The coronavirus disease-2019 (COVID-19) pandemic has caused an enormous strain on healthcare systems and society on a global scale. We report a new phenomenon of medical care avoidance among patients with acute coronary syndrome, which is due to concerns about contracting severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection during hospital stay, ultimately leading to dire clinical outcomes. (Level of Difficulty: Beginner.).

Keywords: COVID-19, coronavirus disease-2019; ECG, electrocardiography; EMS, emergency medical services; ICU, intensive care unit; LAD, left anterior descending artery; LV, left ventricular; MI, myocardial infarction; PCI, percutaneous coronary intervention; SARS-CoV-2, severe acute respiratory syndrome-coronavirus-2; STEMI, ST-segment elevation myocardial infarction; acute coronary syndrome; complication; myocardial infarction.

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Figures

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Graphical abstract
Figure 1
Figure 1
Late-Presentation Anterior Myocardial Infarction Complicated by Apical Thrombosis With Systemic Embolization Patient #1: electrocardiography computed tomography angiography, and echocardiography images showing late-presentation anterior myocardial infarction due to (sub)acute occlusion of the left anterior descending artery (LAD), with subsequent formation of an apical left ventricular (LV) thrombus, which induced thromboembolic showers into both femoral arteries, ultimately leading to critical limb ischemia in the left leg.
Figure 2
Figure 2
Late-Presentation Anterior Myocardial Infarction Complicated by Left Ventricular Aneurysm Formation Patient #2: electrocardiography computed tomography angiography, and echocardiography images showing late-presentation anterior myocardial infarction (caused by plaque rupture on a long severe LAD lesion), with subsequent apical LV aneurysm formation. Abbreviations as in Figure 1.
Figure 3
Figure 3
Late-Presentation Anterior Myocardial Infarction Complicated by Cardiogenic Shock Patient #3: electrocardiography, coronary angiogram, and echocardiography images showing late-presentation anterior myocardial infarction in a patient with chronic total occlusion (CTO) of the left posterolateral branch (LPL) and proximal right coronary artery (RCA), as well as thrombotic occlusion of the mid LAD, which was treated with emergent percutaneous intervention and complicated with the no-reflow phenomenon and cardiac arrest. Transesophageal echocardiography showed extensive akinesia of the anteroseptal, anteroapical, and lateral wall and severe LV dysfunction. Abbreviations as in Figure 1.
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References

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    1. PCM-DPC dati forniti dal Ministero della Salute. Available at: http://www.salute.gov.it/imgs/C_17_pagineAree_5351_32_file.pdf. Accessed May 2020.

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