J Korean Med Sci.  2020 Jul;35(27):e258. 10.3346/jkms.2020.35.e258.

A Case of COVID-19 with Acute Myocardial Infarction and Cardiogenic Shock

• Kim HN
• Lee JH
• Park HS
• Yang DH
• Jang SY
• Bae MH
• Cho Y
• Chae SC
• Lee YH

• KMID: 2504268
• DOI: http://doi.org/10.3346/jkms.2020.35.e258

Abstract

A 60-year-old male patient with coronavirus disease-2019 showed new onset ST-segment elevation in V1–V2 leads on electrocardiogram and cardiac enzyme elevation in intensive care unit. He had a history of type 2 diabetes mellitus, hypertension, and dyslipidemia. He was receiving mechanical ventilation and veno-venous extracorporeal membrane oxygenation treatment for severe hypoxia. Two-D echocardiogram showed regional wall motion abnormalities. We performed primary percutaneous coronary intervention for acute myocardial infarction complicating cardiogenic shock under hemodynamic support. He expired on the 16th day of admission because of cardiogenic shock and multi-organ failure. Active surveillance and intensive treatment strategy are important for saving lives of COVID-19 patients with acute myocardial infarction.

Keyword

SARS-CoV-2; COVID-19; Acute Myocardial Infarction; Cardiogenic Shock

Figure

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  Fig. 1 Chest X-ray images. Chest X-ray on the day of admission (A), day 6 (B), day 14 (C) of hospitalization. Peribronchial ground glass opacities and nodular opacities in both lung fields were deteriorated.

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  Fig. 2 Interval changes of ECG. ECG on the day of admission (A) and day 14 (B) of hospitalization. New onset ST-segment elevation in V1–V2 leads and T wave inversion in V3–V6 leads were observed.aVR = augmented vector right, aVL = augmented vector left; aVF = augmented vector foot, ECG = electrocardiogram.

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  Fig. 3 Scene at the time of procedure. Medical staffs wore level D personal protective equipment including 2 pairs of surgical gloves, N95 mask, goggle, face shield, protective suit, leg covers, and sterile surgical gown.

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  Fig. 4 Baseline coronary angiogram. Coronary angiogram showed severe stenosis in mid portion of left descending coronary artery (A), proximal portion of left circumflex coronary artery (B), and proximal portion of right coronary artery (C). White arrows indicate coronary lesions in each vessel.

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  Fig. 5 Final coronary angiogram after percutaneous coronary intervention. (A) Drug eluting stents were implanted in mid portion of left descending coronary artery and (C) proximal portion of right coronary artery. (B) Balloon angioplasty was done in proximal portion of left circumflex coronary artery.

Reference

1. Driggin E, Madhavan MV, Bikdeli B, Chuich T, Laracy J, Biondi-Zoccai G, et al. Cardiovascular considerations for patients, health care workers, and health systems during the COVID-19 pandemic. J Am Coll Cardiol. 2020; 75(18):2352–2371. PMID: 32201335.

2. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395(10223):497–506. PMID: 31986264.

3. Guzik TJ, Mohiddin SA, Dimarco A, Patel V, Savvatis K, Marelli-Berg FM, et al. COVID-19 and the cardiovascular system: implications for risk assessment, diagnosis, and treatment options. Cardiovasc Res. Forthcoming. 2020; DOI: 10.1093/cvr/cvaa106.

4. Dabbagh MF, Aurora L, D'Souza P, Weinmann AJ, Bhargava P, Basir MB. Cardiac tamponade secondary to COVID-19. JACC Case Rep. Forthcoming. 2020; DOI: 10.1016/j.jaccas.2020.04.009.

5. Monmeneu JV, Mafe ED, Soler JA, Perez BV, Caravaca JS, Torres RB, et al. Subacute perimyocarditis in a young patient with COVID-19 infection. Eur Heart J Case Rep. Forthcoming. 2020; DOI: 10.1093/ehjcr/ytaa157.

6. Meyer P, Degrauwe S, Van Delden C, Ghadri JR, Templin C. Typical takotsubo syndrome triggered by SARS-CoV-2 infection. Eur Heart J. 2020; 41(19):1860. PMID: 32285915.

7. Solano-López J, Sánchez-Recalde A, Zamorano JL. SARS-CoV-2, a novel virus with an unusual cardiac feature: inverted takotsubo syndrome. Eur Heart J. Forthcoming. 2020; DOI: 10.1093/eurheartj/ehaa390.

8. Peigh G, Leya MV, Baman JR, Cantey EP, Knight BP, Flaherty JD. Novel coronavirus 19 (COVID-19) associated sinus node dysfunction: a case series. Eur Heart J Case Rep. Forthcoming. 2020; DOI: 10.1093/ehjcr/ytaa132.

9. Ullah W, Saeed R, Sarwar U, Patel R, Fischman DL. COVID-19 complicated by acute pulmonary embolism and right-sided heart failure. JACC Case Rep. Forthcoming. 2020; DOI: 10.1016/j.jaccas.2020.04.008.

10. Dominguez-Erquicia P, Dobarro D, Raposeiras-Roubín S, Bastos-Fernandez G, Iñiguez-Romo A. Multivessel coronary thrombosis in a patient with COVID-19 pneumonia. Eur Heart J. 2020; 41(22):2132. PMID: 32374373.

11. Stefanini GG, Montorfano M, Trabattoni D, Andreini D, Ferrante G, Ancona M, et al. ST-elevation myocardial infarction in patients with COVID-19: clinical and angiographic outcomes. Circulation. 2020; 141(25):2113–2116. PMID: 32352306.

12. Bangalore S, Sharma A, Slotwiner A, Yatskar L, Harari R, Shah B, et al. ST-segment elevation in patients with COVID-19 - a case series. N Engl J Med. 2020; 382(25):2478–2480. PMID: 32302081.

13. Kim NY, Ha E, Moon JS, Lee YH, Choi EY. Acute hyperglycemic crises with coronavirus disease-19: case reports. Diabetes Metab J. 2020; 44(2):349–353. PMID: 32347027.

14. Libby P, Loscalzo J, Ridker PM, Farkouh ME, Hsue PY, Fuster V, et al. Inflammation, immunity, and infection in atherothrombosis: JACC review topic of the week. J Am Coll Cardiol. 2018; 72(17):2071–2081. PMID: 30336831.

15. The European Society for Cardiology. ESC guidance for the diagnosis and management of CV disease during the COVID-19 pandemic. Updated 2020. Accessed May 28, 2020. https://www.escardio.org/Education/COVID-19-and-Cardiology/ESC-COVID-19-Guidance.

16. Mahmud E, Dauerman HL, Welt FG, Messenger JC, Rao SV, Grines C, et al. Management of acute myocardial infarction during the COVID-19 pandemic. J Am Coll Cardiol. Forthcoming. 2020; DOI: 10.1016/j.jacc.2020.04.039.