Acute myocardial infarction secondary to COVID-19 infection: A case report and review of the literature

Abstract

Background: Thrombotic complications of COVID-19 infection have become increasingly apparent as the disease has infected a growing number of individuals. Although less common than upper respiratory symptoms, thrombotic complications are not infrequent and may result in severe and long-term sequelae. Common thrombotic complications include pulmonary embolism, cerebral infarction, or venous thromboembolism; less commonly seen are acute myocardial injury, renal artery thrombosis, and mesenteric ischemia. Several case reports and case series have described acute myocardial injury in patients with COVID-19 characterized by elevations in serum biomarkers. Case report: Here, we report the first case to our knowledge of a patient with acute coronary syndrome confirmed on catheter angiography and cardiac MRI. This patient was found to additionally have a left ventricular thrombus and ultimately suffered an acute cerebral infarction. Recognition of thrombotic complications in the setting of COVID-19 infection is essential for initiating appropriate therapy. Conclusions: In acute myocardial injury, given the different treatment strategies for myocarditis versus acute myocardial infarction secondary to coronary artery thrombus, imaging can play a key role in clinical decision making for patients.

Pathophysiology and Imaging Findings of COVID-19 Infection: An Organ-system Based Review

“…Acute coronary syndrome stemming from the prothrombotic state has also been reported ( 23 ). A recent case report of a COVID-19 positive patient presenting with acute myocardial infarction diagnosed on coronary angiography and cardiac MR underscored the key role that radiology plays in decision making for patients with elevated myocardial markers ( 24 ). Cardiac indices are image-based parameters that have shown predictive value for increased morbidity and mortality in a variety of conditions.…”

“…As described in Capaccione, et al, in the setting of elevated markers of myocardial injury, cardiac imaging can serve as a critical branch point for diagnosing myocarditis versus myocardial infarction. Given that treatment diverges significantly at this branch point, cardiothoracic imaging can be critical in appropriately diagnosing and treating the patient ( 24 ). Figure 2 A, B demonstrates representative axial and coronal images cardiac MR images of a patient with myocarditis.…”

Acute Mesenteric Ischemia as an Early Complication of COVID-19

“…The binding of the virus to the ACE2 receptors causes endothelial injury, leading to activation of the tissue factor pathway, which causes increased thrombin generation and fibrin formation. The typical finding in patients with COVID-19 is an increase in procoagulants, seen as an increase in prothrombin time, fibrinogen, and D-dimer, indicating a hypercoagulable state with a decrease in platelet count and near-normal activated partial thromboplastin (APTT) [ 3 ]. In our case, we observed an increase in prothrombin time (PT), D-dimer, and international normalized ratio (INR) with normal platelet count.…”

“…COVID-19 causes a hypercoagulable and prothrombotic state in patients [ 1 ]. It is known to cause thrombotic complications such as cerebrovascular accidents, myocardial infarction, arterial occlusion of the lower limb, splanchnic vein thrombosis, portomesenteric vein thrombosis, and mesenteric ischemia [ 3 - 7 ].…”

Echocardiography in COVID-19 Pandemic

“…COVID-19 can cause a wide range of cardiac conditions, that include acute myocardial infarction 9 , 10 , 11 , takotsubo cardiomyopathy 12 , myocarditis 13 , arrhythmogenic 14 , thrombotic manifestations 15 and potential drug-related effects 16 , 17 , 18 , as documented by several studies and early case reports.…”