Acute Myocardial Infarction Due to Microvascular Obstruction in a Young Woman Who Recently Recovered from COVID-19 Infection

Abukar Mohamed Ali,Daanyaal Wasim,Nigussie Bogale,Øyvind Bleie,Terje H Larsen,Sahrai Saeed

doi:10.3390/jcdd8060066

Abukar Mohamed Ali, Daanyaal Wasim + Show 4 more

Open Access

https://doi.org/10.3390/jcdd8060066

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Abstract

Although cardiovascular complications are common in hospitalized COVID-19 patients, those with milder cases who recovered at home are less studied. Here, we report the case of a young woman who recently recovered from COVID-19 at home. A week after recovery, she was admitted to our institution with acute chest pain, signs of ischemia on the electrocardiogram and elevated cardiac troponins. Coronary angiography showed normal epicardial coronary arteries, but the cardiac magnetic resonance showed transmural late gadolinium enhancement (LGE) in the mid-ventricular level of the lateral wall. The findings were strongly suggestive of a minor transmural myocardial infarction. This case report highlights the role of multimodality imaging in detecting cardiac injury in COVID-19 patients as well as the fact that mild COVID-19 cases who recovered at home are also exposed to thromboembolic events during the convalescent period.

Highlights

The majority of patients with coronavirus disease 2019 (COVID-19) experience mild symptoms and recover, more severe forms of the disease may lead to acute respiratory distress syndrome and multiple organ failure
Cardiac injury in COVID-19 has different manifestations ranging from milder forms of chest pain and slightly elevated cardiac troponins and pro-brain natriuretic peptides, to more severe forms of acute coronary syndromes, myocarditis, pericardial effusion, tamponade, stress-cardiomyopathy, right and left ventricular systolic dysfunction, pulmonary hypertension, cardiogenic shock and death [1,2,3,4,5,6]
There are three learning points to this case study: (1) Nonhospitalized COVID-19 patients who are often younger and experience milder symptoms may develop cardiac injury during recovery from COVID-19 infection; (2) Minor myocardial infarctions/injuries may be present despite normal epicardial coronary arteries by conventional angiography and are revealed on CMR; (3) The global LV ejection fraction may be normal, but there may be subtle regional wall motion abnormalities and impaired myocardial strain in the affected segments, suggesting subclinical LV dysfunction and ischemia

Summary

Introduction

The majority of patients with coronavirus disease 2019 (COVID-19) experience mild symptoms and recover, more severe forms of the disease may lead to acute respiratory distress syndrome and multiple organ failure. The cardiovascular (CV) complications of COVID-19 include myocarditis-like injury, acute coronary syndromes, thromboembolic events and arrhythmias [1]. CV complications are common in hospitalized COVID-19 patients, those who recover at home are less studied. In the present case study we present the clinical course of acute myocardial infarction in a 55-year-old woman who recently recovered from COVID-19 at home. 2. Case Presentation We report the case of a 55-year-old woman with no previous cardiovascular disease or history of smoking. Case Presentation We report the case of a 55-year-old woman with no previous cardiovascular disease or history of smoking She tested positive for COVID-19 after exhibiting symptoms of fever, severe cough, headache, shortness of breath and lethargy.

Case Presentation

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