Severe inflammatory response in a patient with ST elevation myocardial

infarction due to COVID-19 infection - Case Report

Bodnaruc Adriana1, Prof. Dr. Benedek Theodora1

1
Clinica Medicala VI - Spitalul Clinic Județean De Urgență, Tîrgu-Mureș
2
Universitatea de Medicină, Farmacie,Științe și Tehnnologie ,,George Emil Palade,,din Tîrgu-Mureș.

Background: It is well known that COVID-19 infection is a major cardiovascular risk factor leading to high
mortality. A severe Inflammatory response characterized by cytokine storm in patients with COVID-19 is
common and may lead to myocardial damage defined by elevated troponin levels.

Objective: The aim of this paper is to present the case of a 54 year old male patient, with recurrent acute
coronary events and multiple cardiovascular comorbidities admitted into the Cardiology Department of the
Emergency County Clinical Hospital of Targu Mures, Romania. Previously, the patient underwent a
complex coronary revascularization with a drug eluting stent implantation due to an acute coronary
syndrome.

Material and Methods: At the current hospitalization, the patient presented with a typical 3-day angina
associated with symptoms of cardiogenic shock - low blood pressure (BP 78/55 mmHg) requiring
inotropic and vasoactive support, heart rate 55 bpm and a recent history of COVID - 19 infection. The
ECG performed in the emergency department showed atrial fibrillation with ST-segment elevation in
postero-infero-lateral leads. Laboratory tests showed severe myocardial damage (high sensitive troponin I
value 24844 to 31832 ng / l), leukocytosis with neutrophilia and severe respiratory acidosis. In the
emergency department, the patient showed sudden hemodynamic damage, with oxygen desaturation of
up to 75%, for which intubation and mechanical ventilation and emergency catheterization were
performed.

Results: The examination was performed under COVID-19 protection and revealed intense angiopathic
left coronary system, with a diameter less than 2 mm, with oversized permeable stent at the level of
anterior descending artery, lesions not suitable for revascularization procedures, the examination
revealed also chronic occlusion of the right artery. Intraprocedural, due to an extreme bradycardia a
temporary pacemaker was implanted, and subsequent the patient was transferred into the intensive-care
COVID unit.

Conclusion: Myocardial infarction in young patients is often associated with traditional risk factors, but
especially with the inflammatory background. COVID-19 infection in cardiovascular patients increases the
inflammatory process and causes the activation of the cytokine storm leading to the acceleration of the
atherosclerotic process (lesions not suitable for revascularization / survival) and severe inflammation of
the endothelium in the coronary arteries.

Key words: COVID-19, myocardial infarction, cardiogenic shock.