Abstract 13233: Covid Related Thrombus or Vasculitis?

Abstract

COVID is associated with cardiovascular manifestations. It worsens the pre-existing cardiovascular diseases, and newly diagnosed cardiovascular diseases are being reported with it. In our abstract we present a case with unusual cardiac manifestation with COVID. 63-years-old, covid positive male with hypertension, hyperlipidemia and coronary artery disease with prior RCA stent was admitted for inferior STEMI.The angiogram showed instent stenosis, with distal vessels narrowing. Stent was placed in RCA. Despite this, he had persistent chest pain and ST elevation, so he was taken back to Cath lab. It confirmed patent stent. For distal vessel narrowing with ongoing pain intra-aortic balloon pump was placed. Aggrastat and heparin was continued. At the time of discharge, he had ongoing dyspnea and chest pain, which was thought to be associated with COVID. He was readmitted in six days for pericardial effusion with constriction and echocardiographic finding of tamponade. He had elevated inflammatory markers and liver enzyme. With recent COVID infection, elevated inflammatory markers, echo findings and known distal coronary artery narrowing there was a concern of vasculitis and pericarditis. He was started on steroid and colchicine with significant improvement. COVID can cause direct myocardial injury or indirect injury due to altered myocardial demand-supply. The pericardial involvement is associated with heightened inflammation and increased vascularity. Interestingly, our patient who initially presented as ACS had resolution of symptoms with steroids. Could ACS symptoms not resolving with antiplatelets and stenting be a part of inflammatory picture of COVID? In post-COVID autopsy and surgical tissue diffuse lymphocytic endotheliitis and apoptotic bodies are seen in the vascular beds. Vasculitis lesion in skin and Kawasaki’s disease is reported in adolescents and children. However, adult-onset vasculitis is still to be studied.