Delayed Treatment of Acute Myocardial Infarction With Ventricular Septal Rupture Due to Patient Fear During the COVID-19 Pandemic

Abstract

During the coronavirus disease 2019 (COVID-19) pandmic, more patients are presenting with complications late after acute myocardial infarction. We report the case of a 71-year-old man who delayed seeking medical care for 2 weeks, despite progressive shortness of breath, cough, and tactile fever, for fear of contracting COVID-19 in the hospital. Clinical and echocardiographic evaluation revealed a ventricular septal rupture secondary to acute myocardial infarction. The patient underwent urgent cardiac catheterization, followed by successful saphenous vein grafting to the left anterior descending coronary artery and open surgical repair of the ventricular septal rupture with a bovine pericardial patch. This case highlights a potential long-lasting negative effect that the COVID-19 pandemic will have on the care-seeking behavior and health of patients with acute cardiovascular disease.

COVID-19 and Cardiometabolic Health: Lessons Gleaned from the Pandemic and Insights for the Next Wave

“…Another systematic review found similar results with a decline in other acute cardiac conditions, including acute coronary syndromes by as much as 50% [47]. The repercussions of these delays and declines are an increase in out of hospital death and more advanced presentations of cardiovascular disease [48,49]. The long-term sequelae of these advanced cardiovascular disease cases may be realized in the years to come.…”

A new dimension to the STEMI-related mortality risk seen in the COVID-19 pandemic era

“…Clinical and echocardiographic recognition of VSR coinciding with electrocardiographic recognition of STEMI ( Table 1 ). In this category there were 42 cases [ [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] ] (28 males) of mean age 67. The period of pre-hospital delay ranged from 6 h to 3 months.…”

“…The period of pre-hospital delay ranged from 6 h to 3 months. Twelve cases had a pre-hospital delay of 7 days or more [ [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] ].…”