Abstract 13169: Cardiac Arrest and Severe Arterial Vasospasm in a 37-Year-Old Woman With Recent Covid Infection

Abstract

CASE: A 37-year-old woman with history of smoking, hypertension and mild COVID-19 diagnosed 40 days prior with intermittent chest pain since then presented to the emergency department (ED) via EMS for an out-of-hospital ventricular fibrillation cardiac arrest. She was resuscitated at home with a downtime of 15 minutes. Her initial ED EKG was normal and she was admitted to the cardiac ICU. Shortly after admission she developed a junctional rhythm with ST elevation in lead II followed by polymorphic ventricular tachycardia which degenerated into ventricular defibrillation. She received 3 shocks with subsequent resuscitation. She was started on an amiodarone drip and underwent coronary angiography. With right femoral artery engagement she was noted to have severe vasospasm. An initial angiogram of the left coronary system showed mild coronary disease, subsequent injection showed diffuse vasospasm in the entire left coronary system. Telemetry showed diffuse ST elevations and QT widening with injections followed by ventricular fibrillation treated with 8 counter-shocks and the addition of lidocaine. An intra-aortic balloon pump was placed prior to transfer back to the ICU. She was initially treated with nicardipine and transitioned to amlodipine for treatment of vasospasm. Rheumatologic work-up was unremarkable and she underwent placement of an ICD for secondary prevention. A Coronary CT was performed in follow-up showing only minimal luminal irregularities with no RCA disease. DISCUSSION: COVID-19 has been linked to many cardiovascular abnormalities including diffuse vasospasm with acute infection. This is the first case describing diffuse vasospasm in a person who is in the post-COVID period which is defined as greater than 4 weeks after diagnosis. This case provides information on severe arterial vasospasm seen in the time period after acute COVID infection indicating that follow up after COVID for any cardiovascular abnormalities is needed.