INTRAMYOCARDIAL DISSECTING HEMATOMA SECONDARY TO DELAYED PRESENTATION ANTEROLATERAL STEMI

Abstract

Background Delayed hospital presentation with STEMI during the SARS-CoV-2 pandemic can lead to increased incidence of typically rare mechanical sequelae Intramyocardial dissecting hematoma (IDH) is one such complication of myocardial infarction Case A 51 year-old male patient with a background of hypertension presented with a 7 hour history of typical chest pain His initial ECG showed anterolateral ST segment elevation with reciprocal ST depression in the inferior leads, consistent with STEMI Urgent angiography revealed a 100% acute occlusion in the mid-LAD TIMI 3 flow was restored using a Xience 3 00 x 18mm stent, with resolution of pain and interval ECG improvement Laboratory investigations revealed new significant anaemia Decision-making Post-procedural transthoracic echocardiography revealed severely impaired systolic function and moderate concentric biventricular hypertrophy, and raised the suspicion of a mechanical complication (see image) This was further supported by his delayed presentation and extensive infarct area His anaemia was suggestive of active haemorrhage Endoscopic investigation failed to show a gastrointestinal source Cardiac MRI (CMR) confirmed the presence of IDH Conclusion This case highlights the need for a heightened index of suspicion for typically rare mechanical complications post-STEMI due to delayed hospital presentation during the current pandemic, as well as the growing utility of multimodality imaging such as CMR [Formula presented]