Spontaneous Coronary Artery Dissection Following SARS-CoV-2-Associated Multisystem Inflammatory Syndrome

Abstract

Spontaneous coronary artery dissection (SCAD) is an underdiagnosed cause of acute coronary syndrome, myocardial infarction, and sudden cardiac death. During the coronavirus disease 2019 (COVID-19) pandemic, a multisystem inflammatory syndrome (MIS) emerged that is incompletely understood. While the involvement of numerous organ systems has been described, the potential cardiovascular manifestations, such as myocarditis, arterial thrombosis, or SCAD, are particularly worrisome. Here, we present a case of MIS that was preceded by an unremarkable case of COVID-19 and followed by the development of SCAD. This case highlights the importance of furthering our understanding of the potential sequelae of COVID-19 and of the potential relationship between SCAD and MIS.

Keywords: covid-19; mis-a; multisystem inflammatory syndrome; myocardial infarction; spontaneous coronary artery dissection.

Figure 1. ECG performed at tertiary care center demonstrating sinus rhythm with a rate of 96 bpm, left axis deviation, premature atrial complexes, ST elevations in V2-V4, and T wave inversions in V1-V4. Concerning for an anteroseptal infarct.

Figure 2. Limited bedside echocardiography demonstrated a mild decrease in left ventricular systolic function with an estimated ejection fraction of 45-49%. Hypokinesis was observed of the basal to apical anterior, septal and apical lateral segments. Wall motion score index was 1.59.

Figure 3. Coronary angiogram in right anterior oblique view with caudal angulation demonstrating type IIa dissection (see arrows) of the left anterior descending artery.

Figure 4. Comprehensive bedside echocardiography demonstrated moderately decreased left ventricular systolic dysfunction via quantitative EF of 39% (modified Simpson biplane). An aneurysm was present in the apex, as was a possible thrombus. Hypokinesis was observed of the anterior and anteroseptal segments, as well as dyskinesis of the apical segments. Wall motion score index was 2.12.