eng Science and Education Publishing American Journal of Medical Case Reports 2374-216X 2020-04-22 8 7 192 196 10.12691/ajmcr-8-7-9 AJMCR2020879 article Pramod Theetha Kariyanna 1 Naseem A. Hossain 1 Apoorva Jayarangaiah 2 Nimrah.A. Hossain 3 Jonathan Christopher Francois 3 Jonathan D. Marmur 3 Moro O. Salifu 3 Samy. I. McFarlane smcfarlane@downstate.edu 3 Department of Internal Medicine, SUNY-Downstate- Health Science University, Brooklyn, New York, U.S.A.- 11203 Division of Hematology-Oncology, Department of Internal Medicine, Albert Einstein College of medicine/Jacobi Medical Center, Bronx, New York, U.S.A 10461 Department of Internal medicine, New York Presbyterian- Brooklyn Methodist Hospital, Brooklyn, New York, U.S.A-11215 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. http://pubs.sciepub.com/ajmcr/8/7/9/ajmcr-8-7-9.pdf COVID-19 ST-segment elevation myocardial infarction (STEMI) Pharmaco-invasive therapy