Prehospitalno detektovan akutni infarkt miokarda sa ST elevacijom kod COVID 19 pozitivnog pacijenta

Abstract

Introduction/Objective Even during the coronary virus disease (COVID-19) pandemic, patients can develop symptoms of acute myocardial infarction with ST elevation (STEMI). We are presenting the case of a COVID-19 positive patient with STEMI diagnosed in a prehospital setting, with differential diagnosis questions during hospitalization and implementation of high personal protection standards by medical staff during his treatment. Case report on 4th April 2020, at 12.26 A.M. a medical emergency team was dispatched to transport a 51-year-old male patient from the Vozdovac Community Health Center infirmary to a catheterization lab for a possible STEMI. Upon arrival at 12.39 P.M., the patient complained of retrosternal chest pain that he described as an 8/10 in severity. The pain commenced two hours earlier at rest. He did not have a respiratory infection and the epidemiological survey for COVID-19 was negative. On examination, he was conscious, oriented, communicative, subfebrile (37.1°C), normotensive (130/70mmHg), eupneic (18 breaths/min), with normal auscultatory breath sounds and a blood oxygen saturation level of 98%. Heart sounds are of regular rate (62 bpm) and rhythm, with no murmurs and no signs of decompensation. The electrocardiography (ECG) recorded at the Health Centre showed an ST elevation in lateral leads, which was confirmed on the ECG recorded by the emergency medical system (EMS). An IV catheter was placed and dual antiplatelet therapy was administered. At the Institute for Cardiovascular Diseases Dedinje, a SARS-COV-2 IgG/IgM rapid test showed that the patient was positive for Coronavirus. Arrangements were made and at 1 P.M. the hemodynamically stable patient was transported directly to the COVID-19 "Dr Dragiša Mišović" hospital catheterization lab. Along with STEMI, the differential diagnosis included myocardial infarction with nonobstructive coronary arteries (MINOCA), pulmonary embolism and myopericarditis, which were excluded after performing coronary angiography, echocardiography and computed tomography pulmonary artery angiography. While treating the patient, the medical staff on all levels used the recommended personal protective equipment. During hospitalization, the patient was hemodynamically stable with no rhythm abnormalities, eupneic, with blood oxygen saturation level ranging from 98-100% on room oxygen. The control nasopharyngeal swab came back SARS Cov2 negative on 5th May 2020. COVID-19 specific therapy was administered. The patient was discharged from the hospital with prescribed cardiac medication. He was ordered to self-isolate at home for 14 days, at which time another control swab would be taken. Conclusion Sometimes, a STEMI diagnosed in the prehospital setting does not represent the final diagnosis and it is necessary to take into consideration other differential diagnostic possibilities. A high level of safety strategy for all medical personnel is recommended on all levels when treating patients.