Spontaneous Coronary Artery Dissection as a Cause of Acute Myocardial Infarction in COVID-19 Patients: A Case Report and Review of the Literature

Abstract

Patients with COVID-19 often experience significant cardiovascular complications, including heart failure, myocarditis, and acute coronary syndrome. We present the case of a male patient with severe COVID-19 pneumonia, complicated with inferior ST-segment elevation myocardial infarction (STEMI), which was attributed to spontaneous coronary artery dissection (SCAD). We also make a review of the literature on case reports of patients with COVID-19 and acute myocardial infarction due to SCAD. Through these clinical cases, a potential correlation between SCAD and COVID-19 infection is implied. Endothelial dysfunction, thrombotic complications, and disturbance of the vascular tone are established COVID-19 sequelae, triggered either by direct viral injury or mediated by the cytokines' storm. These abnormalities in the coronary vasculature and the vasa vasorum could result in SCAD. Moreover, disturbances of the vascular tone can cause coronary vasospasm, a reported precipitant of SCAD. Thus, SCAD should be considered in COVID-19 patients with acute coronary syndrome (ACS), and in the case of STEMI, an early angiographic evaluation, if feasible, should be performed rather than thrombolysis to avoid potential adverse events of the latter in the setting of SCAD.

Keywords: COVID-19 cardiac complications; causes of STEMI in COVID-19 patients; non-atherosclerotic acute myocardial infarction; spontaneous coronary artery dissection.

Figure 1

Chest X-ray on the day of the episode; (L: left side).

Figure 2

Coronary angiography revealing a long, smooth lesion in LCX. The red arrows show the long lesion. (a) RAO cranial angiographic view; (b) RAO caudal angiographic view.

Figure 3

Optical coherent tomographic run depicting the true (TL) and the false lumen (FL) of the dissected vessel.

Figure 4

Repeat coronary angiography of the LCX, revealing angiographic healing. The red arrows show the improvement of the previously affected vessel sections. (a) RAO cranial angiographic view; (b) RAO caudal angiographic view.