American Journal of Medical Case Reports. 2020, 8(7), 192-196
DOI: 10.12691/ajmcr-8-7-9
Open AccessCase Report
Pramod Theetha Kariyanna1, Naseem A. Hossain1, Apoorva Jayarangaiah2, Nimrah.A. Hossain3, Jonathan Christopher Francois1, Jonathan D. Marmur1, Moro O. Salifu1 and Samy. I. McFarlane1,
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
Pub. Date: April 22, 2020
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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