Patients with coronavirus disease 2019 (COVID-19) can present with pneumonia and acute respiratory distress syndrome but rarely with acute myocardial infarction, especially in the absence of known cardiovascular disease risk factors. We present the case of a previously healthy young Ethiopian man with COVID-19 and no known cardiovascular risk factors who was diagnosed with acute ST-elevation myocardial infarction and left ventricular thrombu

Birhan, Yidnekachew Asrat

Getachew, Nebiyu

Huluka, Dawit Kebede

Meshesha, Amha

Sherman, Charles B.

Sikamo, Adane Petros

English

AJOL - African Journals Online

Journal of the Pan African Thoracic Society • Volume 3 • Issue 1 • January-April 2022 | 56 Journal of the Pan African Thoracic Society • Volume 3 • Issue 1 • January-April 2022 | 57Case ReportCOVID-19 and acute ST-elevation myocardial infarction (STEMI) and ventricular thrombus in a young ethiopian man without known cardiac risk factors: A case reportDawit Kebede Huluka1, Yidnekachew Asrat Birhan1, Adane Petros Sikamo1, Nebiyu Getachew1, Amha Meshesha1,  Charles B. Sherman21Department of Internal Medicine, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia, 2Department of Internal Medicine, Warren Alpert Medical School of Brown University, Providence, Rhodes Island, United States.INTRODUCTIONMost of coronavirus disease 2019 (COVID-  19) patients often have mild symptoms or are asymptomatic. Albeit, some patients may present with serious disease including pneumonia and acute respiratory distress syndrome. Patients with traditional cardiovascular disease risk factors like hypertension, diabetes, obesity, male sex, and those with established cardiovascular diseases are considered high-risk patients with increased mortality and morbidity when affected by COVID-19.[1] Cardiovascular system may also be affected by COVID-19 but rarely with acute myocardial infarction, especially in the absence of known cardiovascular risk factors.[2]CASE REPORTA 45-year man developed fever, myalgia, arthralgia, and dry cough of 3  weeks duration. He was evaluated and thought to have typhoid or typhus; he was treated with Ciprofloxacin and Doxycycline. He failed to improve and twelve days prior to admission, his cough became more productive; a chest x-ray showed lower lobe infiltrates. His antibiotics were switch to Augmentin and Azithromycin. A  RT PCR COVID-19 test was obtained and subsequently recorded as positive. Five days prior to admission and while still on home isolation, he experienced chest tightness, exertional fatigue, and anorexia. His symptoms persisted and he visited a different clinic. Investigations revealed WBC 14,200/mm3 (n = 67.7%, L = 11.4%) and troponin 18.16 ng/ml ABSTRACTPatients with coronavirus disease 2019 (COVID-19) can present with pneumonia and acute respiratory distress syndrome but rarely with acute myocardial infarction, especially in the absence of known cardiovascular disease risk factors. We present the case of a previously healthy young Ethiopian man with COVID-19 and no known cardiovascular risk factors who was diagnosed with acute ST-elevation myocardial infarction and left ventricular thrombus.Keywords: Coronavirus disease 2019, ST-elevation myocardial infarction, LV thrombusThis is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.©2022 Published by Scientific Scholar on behalf of Journal of the Pan African Thoracic Societyhttps://patsjournal.orgJournal of the Pan African Thoracic Society*Corresponding author: Dawit Kebede Huluka, Department of Internal Medicine, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia.dndrda97@gmail.comReceived: 23 July 2021 Accepted: 09 October 2021 EPub Ahead of Print: 12 November 2021 Published: 28 January 2022DOI 10.25259/JPATS_26_2021Quick Response Code:Huluka, et al.: COVID-19 and STEMI in a young patientJournal of the Pan African Thoracic Society • Volume 3 • Issue 1 • January-April 2022 | 56 Journal of the Pan African Thoracic Society • Volume 3 • Issue 1 • January-April 2022 | 57(normal: 0.0–0.3 ng/ml). His lipid profile, fasting blood sugar, hemoglobin A1C, electrolytes, and renal function were all normal. His chest x-ray showed mild bibasilar ground-glass opacities and his ECG revealed ST elevation and Q waves in the inferior leads with reciprocal changes in the lateral leads [Figure  1]. Echocardiography was remarkable for inferior wall hypokinesis and LV thrombus with an EF of 40–45%. He was then referred to Eka Kotebe General Hospital, one of the COVID-19 care centers in Addis Ababa.On admission, he lacked all the traditional risk factors for ischemic heart disease. His physical exam was remarkable only for BP: 120/70  mmHg, PR 100 bpm, and SaO2  89-92% on room air. He was treated with aspirin, clopidogrel, enoxaparin overlapping with warfarin, and supplemental oxygen. Angiography, done after discharge, showed occlusion of the left anterior descending and right coronary arteries [Figure  2]. He subsequently had percutaneous coronary intervention (PCI) and is currently asymptomatic.DISCUSSIONEven though respiratory manifestations are the predominant manifestation for COVID-19 illness, COVID-19 can either induce new cardiac pathologies and/or exacerbate underlying cardiovascular diseases.[2] It can affect the cardiovascular system by different mechanisms including direct myocardial damage, severe systemic inflammatory response, hypoxia, right heart strain secondary to ARDS and lung injury, and plaque rupture secondary to inflammation.[3]Our patient had typical features of an acute ST-elevation myocardial infarction (STEMI), namely chest pain, ECG changes, elevated cardiac biomarkers, and echocardiographic and angiographic evidence of coronary artery disease. He developed cardiac symptoms 2 weeks after his initial symptoms and 06  days after COVID-19 RT-PCR positivity. However, he was lacking known risk factor for ischemic heart disease. COVID-19 was likely responsible for his STEMI, possibly mediated by inflammation and/or hypercoagulation.[2-4] This case underscores the need for clinicians to consider further cardiac evaluation in COVID-19  patients presenting with chest pain, regardless of age or lack of known cardiovascular risk factors other than being male.In this particular patient diagnosis of COVID-19 has contributed significantly for the delay in the diagnosis of STEMI and timely guideline-based interventions. A joint position Statement from the society for cardiovascular angiography and interventions, the American College of Cardiology, and the American College of Emergency Physicians emphasizes that primary PCI should remain the standard of care, including for COVID-19 confirmed or probable patients.[5] However, there is a significant delay in hospital presentation of STEMI patients because of the fear of nosocomial COVID-19 transmission.[6] There is also a delay in door to balloon time after hospital presentation especially for COVID-19 suspected/confirmed cases due to logistic issues to facilitate Cardiovascular procedures in the safest possible environment to optimize clinical outcomes and minimize the risk of infection. Fortunately, our patient did well but because COVID-19 patients are treated at COVID-19 treatment facilities with no PCI capacities in Ethiopia there was a delay in PCI intervention.AcknowledgmentWe would like to pass our gratitude to the East African Training Initiative, sponsored by Vital Strategies New York, New  York, USA, and the Swiss Lung Foundation, Zurich, Switzerland.Declaration of patient consentInstitutional Review Board (IRB) permission obtained for the study.Figure 1: ECG showing ST elevation and Q-waves in inferior leads with reciprocal changes on the lateral leads.Figure 2: Coronary angiography showing stenotic lesions in the left anterior descending artery (LAD) and multisite (proximal, mid, and distal) stenotic lesions of the right coronary artery (RCA).Huluka, et al.: COVID-19 and STEMI in a young patientJournal of the Pan African Thoracic Society • Volume 3 • Issue 1 • January-April 2022 | 58 Journal of the Pan African Thoracic Society • Volume 3 • Issue 1 • January-April 2022 | PBFinancial support and sponsorshipNil.Conflicts of interestThere are no conflicts of interest.REFERENCES1. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020;323:1061-9.2. Madjid M, Safavi-Naeini P, Solomon SD, Vardeny O. Potential effects of coronaviruses on the cardiovascular system: A review. JAMA Cardiol 2020;5:831-40.3. Bandyopadhyay D, Akhtar T, Hajra A, Gupta M, Das A, Chakraborty S, et al. COVID-19 Pandemic: Cardiovascular complications and future implications. Am J Cardiovasc Drugs 2020;20:311-24.4. 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;72:2071-81.5. Mahmud E, Dauerman HL, Welt FG, Messenger JC, Rao SV, Grines C, et al. Management of acute myocardial infarction during the COVID-19 pandemic: A  position statement from the society for cardiovascular angiography and interventions (SCAI), the American College of Cardiology (ACC), and the American College of Emergency Physicia. J Am Coll Cardiol 2020;76:1375-84.6. Tam CC, Cheung KS, Lam S, Wong A, Yung A, Sze M, et al. Impact of coronavirus disease 2019 (COVID-19) outbreak on st-segment-elevation myocardial infarction care in Hong Kong, China. Circ Cardiovasc Qual Outcomes 2020;13:e006631.How to cite this article: Huluka DK, Birhan YA, Sikamo AP, Getachew N, Meshesha A, Sherman CB. COVID-19 and acute ST-elevation myocardial infarction (STEMI) and ventricular thrombus in a young ethiopian man without known cardiac risk factors: A case report. J Pan Afr Thorac Soc 2022;3:56-8.

COVID-19 and acute ST-elevation myocardial infarction (STEMI) and ventricular thrombus in a young ethiopian man without known cardiac risk factors: A case report

https://www.ajol.info/index.php/jpats/article/view/239237/226112

COVID-19 and acute ST-elevation myocardial infarction (STEMI) and ventricular thrombus in a young ethiopian man without known cardiac risk factors: A case report

Abstract

Similar works

Full text

Available Versions

AJOL - African Journals Online