Normal Coronary Myocardial Infarction Due to COVID-19: A Case Series
Background: The prevalence of cardiovascular complications in COVID-19 infection varied in different studies. One of these complications is Myocardial Infarction. A disturbance of the blood supply can lead to Myocardial Infarction by clot formation in the arteries. However, no evidence of significant coronary stenosis has been found in more than 50% of patients with COVID-19 and ST elevation.
Case presentation: 38 and 49 years old men (patients 1, 2) were admitted to our hospital with the complaint of typical chest pain and COVID-19 symptoms. The Real-time Polymerase Chain Reaction (RT-PCR) test confirmed COVID-19 in both. Patient 1 represented inferior posterior ST-Elevation Myocardial Infarction (STEMI) in his Electrocardiogram (ECG). Also, patient 2 has ST-elevation in high lateral and septal leads (I, Augmented Vector Left (AVL), V1, V2) and ST-segment depression in AVR and inferior leads (III, Augmented Vector Foot (AVF)). Their troponin was positive. The vital signs were normal in both of them. Patient 2 just had a history of Aortic Valve Replacement (AVR) 5 years ago. However, Patient 1 had no medical history. Trans-Thoracic Echocardiography (TTE) data demonstrated some disturbances in patient 1 severe hypokinesia of inferior, posterior, lateral, and septal walls. However, TTE data were unremarkable for patient 2. We prescribed recommended medications for them. Therefore, their ECG changes were corrected, and his condition improved. In addition, coronary angiography was done that demonstrated patent and normal coronary arteries in both of them.
Conclusion: COVID-19 infection can cause normal coronary arteries Myocardial Infarction with probable two mechanisms prolonged vasospasm or intraluminal coronary thrombogenesis.