ST Elevation in the COVID-19 Era: A Diagnostic Challenge

Abstract

Background: Severe acute respiratory syndrome coronavirus 2 induces a marked prothrombotic state with varied clinical presentations, including acute coronary artery occlusions leading to ST-elevation myocardial infarction (STEMI). However, while STEMI on electrocardiogram (ECG) is not always associated with acute coronary occlusion, this diagnostic uncertainty should not delay cardiac catheterization. Case Reports: We present 2 cases of patients with COVID-19 that presented with STEMI on ECG. While both patients underwent cardiac catheterization, a delay in time to intervention in the patient found to have acute coronary artery occlusion may have contributed to a poor outcome. Why Should an Emergency Physician Be Aware of This?: These cases highlight the fact that while not all COVID-19 patients with STEMI on ECG will have acute coronary artery occlusions, there is continued need for prompt percutaneous coronary intervention during the severe acute respiratory syndrome coronavirus 2 pandemic.

Myocardial Ischemia in Patients with COVID-19 Infection: Between Pathophysiological Mechanisms and Electrocardiographic Findings

“…We researched almost all published cases of STEMI and we found an approximately equal localization of the myocardial infarction, with no statistical significance between the affected walls: inferior myocardial infarction-5 cases, inferolateral myocardial infarction-4 cases, anterior myocardial infarction-5 cases, or anterolateral myocardial infarction-3 cases. Interestingly, patients who had a subacute myocardial infarction, with ST-segment elevation and Q waves, had an anterior STEMI with late presentation [ 3 , 11 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 ]. Patients with COVID-19 and STEMI who were admitted to the hospital had several cardiovascular risk factors with a past medical history of type 2 diabetes mellitus, hypertension, hyperlipidemia, or overweight body mass index (BMI) [ 98 , 104 ].…”

“…This suggests that cardiovascular risk factors in patients with COVID-19 infection play an important role, as this association leads to a more prevalent occurrence of a myocardial infarction. The mean age of the total cases of STEMI associated with COVID-19 infection found in literature was 54.4 years of age, and the majority of patients were male, only four being female with acute STEMI [ 3 , 11 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 ]. However, it was observed that the youngest patients with ST-segment elevation myocardial infarction and COVID-19 were female [ 109 , 110 ].…”

Uma proposta para melhor entendimento das injúrias miocárdicas em pacientes infectados pelo COVID-19

“…Diversos estudos comprovaram o pior prognóstico destes pacientes quando portadores de fatores de risco cardiovascular já estabelecidos como idade, hipertensão, obesidade e diabetes [5][6][7][8] . Entretanto, complicações cardiovasculares consequentes à infecção também foram descritas em relatos de caso e séries de pacientes, algumas relacionadas à trombose [9][10][11][12][13][14][15][16][17][18] e outras relacionadas à agressão direta do vírus ao miocárdio e pericárdio 15,[19][20][21][22][23][24] .…”