Presentation Title

Sars-Cov 2 Infection Complicating ST Elevation Myocardial Infarction

Format

Poster

Start Date

6-11-2020 1:45 PM

End Date

6-11-2020 2:00 PM

Abstract

Joel Brooks Tamayo Joel, MD, Internal Medicine, Kendall Regional Medical Center. Fernando Frias, MD, Internal Medicine, Brandon Regional Medical Center. Daniel Gonzalez, MD, Internal Medicine, Kendall Regional Medical Center. Yoandy Rodriguez, MD, Faculaty MD, faculty. Jose Gascon, MD, Program Director Introduction The new coronavirus emerged in late 2019 in Wuhan, China, in a short period of time it became a pandemic with 5,551,793 cases in the United States and over 170,000 deaths. Patients with established cardiovascular disease represent a vulnerable population and cardiac injury in the context of Sars-Cov 2 infection increases the risk of death. Case report This is a 67 yo M with PMHx significant for T2DM who presents to ED c/o severe retrosternal pain, constant, radiated to the left arm. It was associated with diaphoresis. Absent fever, dyspnea, cough, diarrhea. Reports positive covid 19 PCR one week prior presentation. Labs: Elevated troponin I, CRP, and D-Dimer. Positive Sars-Cov 2 PCR EKG: NSR. 3 mm elevation of the J point in inferior and low lateral leads with reciprocal changes L1, AVL and V1-V3. Patient was transferred to the Cardiac suite. Left heart catheterization showed a thrombotic occlusion of the RCA. A stent was implanted in the proximal RCA. Discussion This patient presentation was consistent with Type 1 Myocardial Infection (MI), caused by plaque rupture with thrombus formation. The most accepted explanation is that circulating cytokines released during a severe systemic inflammatory state could lead to plaque instability and rupture. The fact a patient has Sars-Cov 2 infection should not compromise timely reperfusion. PCI should the primary reperfusion strategy. If the target time cannot be achieved, fibrinolysis should be started in absence of contraindications. Conclusion The incidence of STEMI in infected patients during the Sars-Cov 2 outbreak is unknown. There are very scarce data about symptoms and electrocardiographic changes related to STEMI in Sars-Cov 2 infection. PCI should be the primary reperfusion strategy. Key words: Sars-Cov 2, STEMI, MI

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Nov 6th, 1:45 PM Nov 6th, 2:00 PM

Sars-Cov 2 Infection Complicating ST Elevation Myocardial Infarction

Joel Brooks Tamayo Joel, MD, Internal Medicine, Kendall Regional Medical Center. Fernando Frias, MD, Internal Medicine, Brandon Regional Medical Center. Daniel Gonzalez, MD, Internal Medicine, Kendall Regional Medical Center. Yoandy Rodriguez, MD, Faculaty MD, faculty. Jose Gascon, MD, Program Director Introduction The new coronavirus emerged in late 2019 in Wuhan, China, in a short period of time it became a pandemic with 5,551,793 cases in the United States and over 170,000 deaths. Patients with established cardiovascular disease represent a vulnerable population and cardiac injury in the context of Sars-Cov 2 infection increases the risk of death. Case report This is a 67 yo M with PMHx significant for T2DM who presents to ED c/o severe retrosternal pain, constant, radiated to the left arm. It was associated with diaphoresis. Absent fever, dyspnea, cough, diarrhea. Reports positive covid 19 PCR one week prior presentation. Labs: Elevated troponin I, CRP, and D-Dimer. Positive Sars-Cov 2 PCR EKG: NSR. 3 mm elevation of the J point in inferior and low lateral leads with reciprocal changes L1, AVL and V1-V3. Patient was transferred to the Cardiac suite. Left heart catheterization showed a thrombotic occlusion of the RCA. A stent was implanted in the proximal RCA. Discussion This patient presentation was consistent with Type 1 Myocardial Infection (MI), caused by plaque rupture with thrombus formation. The most accepted explanation is that circulating cytokines released during a severe systemic inflammatory state could lead to plaque instability and rupture. The fact a patient has Sars-Cov 2 infection should not compromise timely reperfusion. PCI should the primary reperfusion strategy. If the target time cannot be achieved, fibrinolysis should be started in absence of contraindications. Conclusion The incidence of STEMI in infected patients during the Sars-Cov 2 outbreak is unknown. There are very scarce data about symptoms and electrocardiographic changes related to STEMI in Sars-Cov 2 infection. PCI should be the primary reperfusion strategy. Key words: Sars-Cov 2, STEMI, MI