ST-segment elevation in chronic bleeding post-curettage with COVID-19 antibodies: A case report

Abstract

Acute coronary syndrome has a variety of symptoms and remains poorly under diagnosed and under treatment in women, especially myocardial infarction or ischaemic with non-obstructive coronary arteries (INOCA) as the culprit. We present a case of an Indonesian adult female with hypoxemia and ST-elevation in post-curettage due to molar pregnancy and positive COVID-19 antibodies.A 43-year-old Indonesian female was admitted due to confusion, dyspnoea, and chronic bleeding after the curettage. The electrocardiogram (ECG) showed ST-elevation in lead I and aVL. Her condition quickly stabilised after getting oxygen supplementation and nitro-glycerine with ST-elevation resolution and no neurological impairments. Due to COVID-19 pandemic, she was checked for a swab test which showed negative but positive on her antibodies test. Chest X-ray was normal, but the echocardiography showed mild left atrial dilatation. After standard atherosclerosis treatment and anticoagulant, her condition improved, despite recurring vaginal bleeding. During her outpatient follow-ups, suspected intrauterine leiomyoma was diagnosed by ultrasound. Cytokines and inflammatory responses from prolonged bleeding, hormones, metabolic disturbances, and post-COVID-19 infection have the potential to provoke INOCA. Considering the complexity of our case, contributing factors to INOCA must be addressed to optimise the strategy. Further, imaging tests should be done to confirm the diagnosis.