Filipiak-Strzecka, Dominika

Frynas-Jończyk, Karolina

Kasprzak, Jarosław D.

Lipiec, Piotr

Plewka, Michał

Szymczyk, Ewa

Szymczyk, Konrad

Via Medica Journals

Address for correspondence: Dominika Filipiak-Strzecka, PhD, Chair and Department of Cardiology, Medical  University of Lodz, Bieganski Hospital, ul. Kniaziewicza 1/5, 91–347 Łódź, Poland, tel/fax: +48 42 2516216,  e-mail: dominika.filipiak@gmail.comReceived: 9.02.2022 Accepted: 19.05.2022This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.Cardiology Journal2022, Vol. 29, No. 5, 878–879DOI: 10.5603/CJ.2022.0083Copyright © 2022 Via MedicaISSN 1897–5593eISSN 1898–018XIMAGE IN CARDIOVASCULAR MEDICINEcovid-19Acute myocardial injury as a sole  presentation of COVID-19 in patient  without cardiovascular risk factorsDominika Filipiak-Strzecka1, Michał Plewka1, 2, Ewa Szymczyk1,  Karolina Frynas-Jończyk1, Konrad Szymczyk1, Piotr Lipiec1, Jarosław D. Kasprzak11Department and Chair of Cardiology, Medical University of Lodz, Bieganski Hospital, Lodz, Poland2Department of Interventional Cardiology and Cardiac Arrhythmias, Medical University of Lodz, PolandA previously healthy 49-year-old male without cardiovascular risk factors was admitted to the cardiology ward with severe resting chest pain. No fever, cough or dyspnea was reported. electrocardi-ography examination showed ST segment elevation in the inferior leads. His troponin-T level was in-creasing from 16 to 266 ng/L. Markers and NT-pro- -B-type natriuretic peptide levels were elevated. Urgent coronarography exposed no hemodynami-cally significant abnormalities (Fig. 1A, C). Per-sisting chest pain led to the angio-computed to-mography (CT) and high resolution CT excluding pneumonia or acute aortic dissection. However, the patient tested positive for coronavirus disease 2019 (COVID-19) RT-PCR and was transferred to the COVID-19 cardiac ward. Echocardiography showed left ventricular (LV)-wall motion abnormali-ties within the inferolateral wall and septum, LV ejection fraction: 43% and LV global longitudinal strain: –14%. Five-day treatment with remdesivir was implemented. The initial diagnosis of myocar-ditis was proposed but magnetic resonance imaging (MRI) performed after 14 days showed suben-docardial late gadolinium enhancement (50–75% wall thickness, locally transmural; Fig. 1E) in the middle and apical segments of inferolateral wall. Subendocardial high T2 signal intensity indicated myocardial edema (Fig. 1F, G). As MRI was strongly suggestive for ischemic lesion, coronarography was reassessed and an overlooked minor postero-lateral branch thrombus with late phase contrast retention was detected. Thus, final diagnosis was COVID-19-related thrombotic coronary occlusion (Fig. 1B). After 15 days the patient was discharged in a good general condition. One-year follow-up echocardiography confirmed persisting small (< 1 segment) hypokinetic area with abnormal local strain and recovered global LV function (Fig. 1D). This report highlights difficult differential diagnosis of acute cardiac injury in COVID-19, in this case due to an unexpected intracoronary thrombosis in normal coronary arteries.Conflict of interest: None declared878 www.cardiologyjournal.orgFigure 1. A–C. Views from coronarography; A. Right coronary artery, early phase of contrast enhancement; B. Right coronary artery, late phase, contrast retention in a minor posterolateral branch marked with an arrow; C. Normal left coronary artery with recessive circumflex artery; D. Echocardiographic examination after one year, bullseye view showing small region of abnormal local strain located in the inferolateral wall; E–G. Cardiac magnetic resonance views; E. Subendocardial late gadolinium enhancement detected in the middle and apical segments of inferolateral wall (marked with an arrow); F, G. Subendocardial high T2 signal intensity indicated myocardial edema (arrows).A BC D EF Gwww.cardiologyjournal.org 879Dominika Filipiak-Strzecka et al., Acute myocardial injury as a sole presentation of COVID-19

Acute myocardial injury as a sole presentation of COVID-19 in patient without cardiovascular risk factors

https://journals.viamedica.pl/cardiology_journal/article/download/CJ.2022.0083/68999

Acute myocardial injury as a sole presentation of COVID-19 in patient without cardiovascular risk factors

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