DOI: 10.12890/2020_001913
Transient ST Segment Elevation in a Patient with COVID-19 and a Normal Transthoracic Echocardiogram
Authors
akinsara@yahoo.com
Keywords
ST segment elevation, COVID-19, echocardiogramAbstract
The effect of COVID-19 on the cardiovascular system still needs to be clarified. Patients can develop a spectrum of cardiac diseases, from mild myocarditis to acute coronary syndrome with an impaired systolic fraction. We describe an interesting case of transient ST segment elevation in a COVID-19 patient admitted to ICU for severe respiratory distress syndrome. During his stay in ICU, the patient developed transient ST segment elevation in inferior-lateral leads which promptly resolved without requiring any additional invasive and/or pharmacological treatment.
Transthoracic echocardiography showed a preserved ejection fraction without any regional abnormalities and the rise in enzyme biomarkers was insignificant. The case highlights the importance of avoiding invasive procedures in this subset of patients to reduce both patient complications and medical staff exposure. Careful evaluation including echocardiogram and second-line examinations should be performed before invasive and aggressive treatment is undertaken.
References
- Fried JA, Ramasubbu K, Bhatt R, Topkara VK, Clerkin KJ, Horn E, et al. The variety of cardiovascular presentations of COVID-19. Circulation 2020;141(23):1930–1936.
- Shi S, Qin M, Shen B, Cai Y, Liu T, Yang F, et al. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. JAMA Cardiol 2020;5(7):802–810.
- Hu H, Ma F, Wei X, Fang Y. Coronavirus fulminant myocarditis saved with glucocorticoid and human immunoglobulin. Eur Heart J 2020 Mar 16. doi: 10.1093/eurheartj/ehaa190 [Epub ahead of print].
- Inciardi RM, Lupi L, Zaccone G, Italia L, Raffo M, Tomasoni D, et al. Cardiac involvement in a patient with coronavirus disease 2019 (COVID-19). JAMA Cardiol 2020;57):1–6.
- He J, Wu B, Chen Y, Tang J, Liu Q, Zhou S, et al. Characteristic ECG manifestations in patients with COVID-19. Can J Cardiol 2020 Mar 29. doi: 10.1016/j.cjca.2020.03.028 [Epub ahead of print].
- Welt FGP, Shah PB, Aronow HD, Bortnick AE, Henry TD, Sherwood MW, et al. Catheterization laboratory considerations during the coronavirus (COVID-19) pandemic: from ACC's Interventional Council and SCAI. J Am Coll Cardiol 2020;75(18):2372–2375.
- Bangalore S, Sharma A, Slotwiner A, Yatskar L, Harari R, Shah B, et al. ST-segment elevation in patients with Covid-19 - a case series. N Engl J Med 2020;382(25):2478–2480.
- Mosleh W, Chen K, Pfau SE, Vashist A. Endotheliitis and endothelial dysfunction in patients with COVID-19: its role in thrombosis and adverse outcomes.J Clin Med 2020;96):E1862.
- Courand PY, Harbaoui B, Bonnet M, Lantelme P. Spontaneous coronary artery dissection in a patient with COVID-19. JACC Cardiovasc Interv 2020;13(12):e107–e108.
- Asif T, Ali Z. Transient ST segment elevation in two patients with COVID-19 and a normal transthoracic echocardiogram. Eur J Case Rep Intern Med 2020;7(5):001672.