COVID-19 infection complicated by acute ST-elevation myocardial infarction

Abstract

Clinicians should be aware of the potential for cardiovascular involvement in COVID-19 infection. Coronavirus disease-2019 (COVID-19) is a viral illness caused by severe acute respiratory syndrome-coronavirus-2. While it primarily causes a respiratory illness, a number of important cardiovascular implications have been reported. We describe a patient presenting with COVID-19 whose hospital course was complicated by ST elevation myocardial infarction requiring percutaneous coronary intervention. The goal is to help clinicians gain awareness of the possibility of cardiovascular disease in COVID-19 infection, and maintain a high index of suspicion particularly for patients with risk factors or a prior history of cardiovascular disease.

Keywords: COVID-19; Cardiac CT; Cardiothoracic imaging; Coronary artery disease; Myocardial infarction; Percutaneous coronary intervention.

Fig. 1

Cardiac CT for calcium scoring 2 years prior to presentation. Axial CT MIP (maximum intensity projection) image demonstrates extensive three vessel coronary artery calcifications (arrows) with a Agatson score of 2050 (L main: 236.4, LAD- 1277.2, LCx – 381.2, RCA- 155.6.).

Fig. 2

Axial CT in lung window (2A) demonstrates extensive peripheral ground glass and consolidative opacities (arrows) typical for COVID-19 pneumonia. The 3D volume rendered image (2B) shows the complete extent of bilateral lung involvement.

Fig. 3

Catheter angiographic image showing complete occlusion of the large dominant left circumflex artery (3A). Angiographic image following percutaneous coronary intervention (PCI) and drug eluting stent (DES) placement with excellent angiographic results and no residual stenosis (3B). Post PCI left ventriculography showed normalization of LV wall motion and function (not shown).