Pharmaco-invasive Therapy for STEMI in a Patient with COVID-19: A Case Report

Pramod Theetha Kariyanna¹, Naseem A. Hossain¹, Apoorva Jayarangaiah², Nimrah.A. Hossain³, Jonathan Christopher Francois¹, Jonathan D. Marmur¹, Moro O. Salifu¹ and Samy. I. McFarlane^1,

¹Department of Internal Medicine, SUNY-Downstate- Health Science University, Brooklyn, New York, U.S.A.- 11203

²Division of Hematology-Oncology, Department of Internal Medicine, Albert Einstein College of medicine/Jacobi Medical Center, Bronx, New York, U.S.A 10461

³Department of Internal medicine, New York Presbyterian- Brooklyn Methodist Hospital, Brooklyn, New York, U.S.A-11215

Cite this paper:
Pramod Theetha Kariyanna, Naseem A. Hossain, Apoorva Jayarangaiah, Nimrah.A. Hossain, Jonathan Christopher Francois, Jonathan D. Marmur, Moro O. Salifu and Samy. I. McFarlane. Pharmaco-invasive Therapy for STEMI in a Patient with COVID-19: A Case Report. American Journal of Medical Case Reports. 2020; 8(7):192-196. doi: 10.12691/ajmcr-8-7-9

Abstract

Coronavirus disease 2019 (COVID-19) is a pandemic that started in the Wuhan province of China in December 2019. It is associated with increased morbidity and mortality mainly due to severe acute respiratory syndrome 2 (SARS-Cov-2). Cardiac manifestations related to COVID-19 include demand ischemia, fulminant myocarditis, myocardial infarction and arrhythmias. In this report, we present a case of ST-segment elevation myocardial infarction (STEMI) in a 68-year-old man with COVID-19 who initially presented with chest pain and shortness of breath. Patient's STEMI was managed with pharmaco-invasive strategy with tissue plasminogen activator (t-PA). He then developed acute hypoxic respiratory failure that was managed in the intensive care unit (ICU), together with multi-organ failure from which the patient died 2 days after presentation. Although the pathophysiologic mechanisms of STEMI in COVID-19 patients has not been clearly established, we hypothesize that interrelated pathogenetic factors, that we highlight in this report, can play a role in the development of STEMI, including plaque rupture secondary to systemic inflammation, increased pro-coagulants, endothelial dysfunction, impaired fibrinolysis and impaired oxygen utilization leading to demand/ supply mismatch and myocardial ischemia.

Keywords:
COVID-19 ST-segment elevation myocardial infarction (STEMI) Pharmaco-invasive therapy

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