Coronary thrombosis in a young male with COVID-19

COVID-19 and coronary artery disease; A systematic review and meta-analysis

Background and aim

Patients with underlying cardiovascular disorders such as coronary artery disease (CAD) are more prone to severe forms and multiple complications of COVID-19. The present systematic review and meta-analysis aimed to investigate the impact of CAD on patients with COVID-19.

Methods

Main electronic databases, including Medline (via PubMed), EMBASE, and Web of Science, were carefully searched and reviewed for original research articles published between 2019 and 2021. One hundred nine studies that address CAD in patients with COVID-19 were selected and analyzed.

Results

Following search and screening processes, 109 relevant publications were selected for analysis. The meta-analysis of prevalence studies indicated that the frequency of CAD among patients with COVID-19 was reported in 10 countries with an overall frequency of 12.4% [(95% CI) 11.1-13.8] among 20079 COVID-19 patients. According to case reports/case series studies, 50.9% of COVID-19 patients suffered from CAD. Fever was the most common symptom in these patients (47%); 36.5% also had hypertension.

Conclusion

The results obtained during the present study show that the simultaneous presence of COVID-19 and CAD, especially in men and elderly patients, can increase the risks and complications of both diseases. Therefore, careful examination of the condition of this group of patients for timely diagnosis and treatment is strongly recommended.

Acute Myocardial Infarction in a Young Male With COVID-19 Infection

Coronavirus disease 2019 (COVID-19) infection is a global health crisis resulting in significant morbidity and mortality. The presentation of COVID-19 infection is variable, ranging from an asymptomatic carrier state to multi-organ failure. While cases of COVID-related myocarditis and myocardial dysfunction are well reported, only a few cases of coronary artery thrombosis resulting in myocardial infarction are noted on literature review. However, the previously reported cases were in patients with high risk for coronary artery disease. We hereby report a case of a young man with no significant past medical history or cardiovascular risk factors who presented with severe chest pain and was diagnosed with acute myocardial infarction in the setting of COVID-19 infection requiring intervention. We want to report this case to improve awareness in the community about COVID-related arterial thrombosis and have a high index of suspicion for this regardless of the person's risk factors for cardiovascular diseases.

Bilateral basal ganglia ischemia associated with COVID-19: a case report and review of the literature

Background

Coronavirus disease 2019, caused by the severe acute respiratory syndrome coronavirus 2, has a broad clinical spectrum, from asymptomatic to multi-organ dysfunction. Acute cerebrovascular events associated with coronavirus disease 2019 are mainly due to the severe acute respiratory syndrome coronavirus 2-induced prothrombotic state. Bilateral basal ganglia ischemia is rarely reported.

Case presentation

We report the case of a 64-year-old Asian (Pakistani) gentleman who presented initially with fever, cough, and shortness of breath, likely due to respiratory involvement by severe acute respiratory syndrome coronavirus 2. Later, he developed bilateral lower limb pain, followed by confusion and decreased level of consciousness. Accentuated large hypodense opacities were seen in the left and right basal ganglia, with mass effects on the left frontal horn.

Conclusion

This case demonstrates the importance of neuroimaging in the effective management of patients with neurological signs associated with coronavirus disease 2019.

Acute myocardial infarction in COVID-19 patients. A review of cases in the literature

INTRODUCTION

COVID-19 is an ongoing pandemic that has lasted more than a year. Patients with multiple comorbidities such as diabetes, hypertension, and smoking have been shown to be at increased risk of a more severe course and lethal outcome. Since the disease can also lead to a hypercoagulable state, several cases of acute myocardial infarction (AMI) have also been recorded.

MATERIAL AND METHODS

We searched PubMed/Medline for case reports of AMI occurring in COVID-19 positive patients using "acute myocardial infarction", "COVID-19", and "SARS-CoV-2" as keywords.

RESULTS

Thirty-three articles covering 37 patients were identified, among which 30 (81.1%) were male, and 7 (18.9%) were females. The mean age of these 37 patients was 52.8 ±15.6 years. Most cases were from the United States (17 cases, 45.9%). Several comorbidities such as hypertension (16 cases, 43.2%), diabetes (14 cases, 37.8%), smoking (8 cases, 21.6%), obesity (3 cases, 8.1%), morbid obesity (1 case, 2.7%), and elevated lipid levels (4 cases, 10.8%) were also identified. The most common symptom of AMI was chest tightness (22 cases, 59.5%), while the most common symptoms for COVID-19 were dyspnoea (25 cases, 67.6%) and fever (22 cases, 59.5%). The mortality rate was 35.1%.

CONCLUSIONS

Given the high mortality rate, physicians are encouraged to properly check for signs of cardiac dysfunction and possible AMI while treating COVID-19 positive patients with several comorbidities or previous history of AMI.

Acute Myocardial Infarction Due to Microvascular Obstruction in a Young Woman Who Recently Recovered from COVID-19 Infection

Although cardiovascular complications are common in hospitalized COVID-19 patients, those with milder cases who recovered at home are less studied. Here, we report the case of a young woman who recently recovered from COVID-19 at home. A week after recovery, she was admitted to our institution with acute chest pain, signs of ischemia on the electrocardiogram and elevated cardiac troponins. Coronary angiography showed normal epicardial coronary arteries, but the cardiac magnetic resonance showed transmural late gadolinium enhancement (LGE) in the mid-ventricular level of the lateral wall. The findings were strongly suggestive of a minor transmural myocardial infarction. This case report highlights the role of multimodality imaging in detecting cardiac injury in COVID-19 patients as well as the fact that mild COVID-19 cases who recovered at home are also exposed to thromboembolic events during the convalescent period.

ST-Elevation Myocardial Infarction in a 23-Year-Old Female: The Mystery of Thrombus Formation

Acute ST-elevation myocardial infarction (STEMI) is rarely seen in young adults, however, when encountered, the underlying cause is either a genetic condition leading to early-onset coronary artery disease (CAD), an acquired pro-thrombotic condition, or an idiopathic condition like spontaneous coronary artery dissection (SCAD). Our case describes a healthy 23-year-old female who presented with sudden onset severe angina and was found to have a laminated thrombus in the left anterior descending coronary artery (LAD), with no evidence of intraluminal dissection or plaque rupture. Although the underlying etiology of thrombus formation remains unknown, coronavirus disease 2019 (COVID-19) related thrombotic event is the prime suspect. In addition, another culprit that cannot be excluded is phentermine-induced coronary vasospasm, a commercially available medication for weight loss. This report addresses current literature on acute coronary syndromes in young adults and reviews the potential etiologies for coronary artery thrombosis, which led to a near-fatal acute coronary syndrome in our patient.

An unusual and atypical presentation of the novel coronavirus: A case report and brief review of the literature

The coronavirus disease 2019 (COVID-19) is a highly contagious novel infection that predominantly presents with fever and respiratory symptoms. However, COVID-19 can masquerade as an acute coronary syndrome, leg pain or swelling with venous thrombosis, loss of consciousness with cerebral venous thrombosis, confusion, limb weakness with brain infarction, facial neuralgia, acute conjunctivitis, acute appendicitis, and testicular pain. We report on a 42-year-old man who presented with mild symptoms of COVID-19. The patient's electrocardiogram showed an ST-segment elevation myocardial infarction (STEMI) due to a left coronary thrombosis. The patient was managed conservatively with medicines and had an uneventful recovery. Emergency physicians should have a high index of suspicion for the unusual presentations of COVID-19.

The Role of Anticoagulation in Post-COVID-19 Concomitant Stroke, Myocardial Infarction, and Left Ventricular Thrombus: A Case Report

Patient: Male, 65-year-old

Final Diagnosis: Heart failure • myocardial infarction • stroke

Symptoms: Right sided weakness

Medication:—

Clinical Procedure: CT scan • echocardiography

Specialty: Cardiology • Infectious Diseases • Medicine, General and Internal • Neurology

Post COVID-19 fibrosis, an emerging complicationof SARS-CoV-2 infection

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Lung fibrosis is an emerging complication of SARS-CoV-2 infection.

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Exertional desaturation may be present in treated COVID-19 patients at discharge.

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A 6-minute walk test may be of prognostic value on COVID patients at discharge.

SARS-COV-2 has created one of the most massive pandemics in modern history. There is a rapid accumulation of data on its epidemiology, clinical course, diagnosis, management, and complications. One of the sequelae of COVID-19 pneumonia and acute respiratory distress syndrome (ARDS) is pulmonary fibrosis. There is a dearth of accurate data on the prevalence of pulmonary fibrosis post-COVID-19. We report a patient who developed dyspnea secondary to pulmonary fibrosis after successful treatment of COVID-19 pneumonia.

Therapeutic Implications of COVID-19 for the Interventional Cardiologist

Although COVID-19 is viewed primarily as a respiratory disease, cardiovascular risk factors and disease are prevalent among infected patients and are associated with worse outcomes. In addition, among multiple extra-pulmonary manifestations, there has been an increasing recognition of specific cardiovascular complications of COVID-19. Despite this, in the initial stages of the pandemic there was evidence of a reduction in patients presenting to acute cardiovascular services. In this masterclass review, with the aid of 2 exemplar cases, we will focus on the important therapeutic implications of COVID-19 for interventional cardiologists. We summarize the existing evidence base regarding the varied cardiovascular presentations seen in COVID-19 positive patients and the prognostic importance and potential mechanisms of acute myocardial injury in this setting. Importantly, through the use of a systematic review of the literature, we focus our discussion on the observed higher rates of coronary thrombus burden in patients with COVID-19 and acute coronary syndromes.

A Review of Coronary Artery Thrombosis: A New Challenging Finding in COVID-19 Patients and ST-elevation Myocardial Infarction

As the COVID-19 pandemic continues, more information on the nonrespiratory effects of the coronavirus is obtained. Cardiovascular complications, especially acute coronary syndromes, are rare. However, they prove to be effective factors in the mortality rate of COVID-19 subjects. Acute ST-elevation myocardial infarction with a special angiographic pattern in the form of extensive and multivessel thrombosis, regardless of atherosclerotic plaques, has posed a new therapeutic challenge. This has been associated with an increase in the incidence of stent thrombosis. Hypercoagulation, due to severe inflammation, is the main pathology of this phenomenon. Technically, percutaneous coronary intervention with aspiration thrombectomy and injectable antiplatelet are the mainstay of treatment for these patients. In addition, it is vital that appropriate antiplatelet and ischemia treatment after the intervention be taken into account.

Statin use is associated with lower disease severity in COVID-19 infection

We aim to study the association of hyperlipidemia and statin use with COVID-19 severity. We analysed a retrospective cohort of 717 patients admitted to a tertiary centre in Singapore for COVID-19 infection. Clinical outcomes of interest were oxygen saturation ≤ 94% requiring supplemental oxygen, intensive-care unit (ICU) admission, invasive mechanical-ventilation and death. Patients on long term dyslipidaemia medications (statins, fibrates or ezetimibe) were considered to have dyslipidaemia. Logistic regression models were used to study the association between dyslipidaemia and clinical outcomes adjusted for age, gender and ethnicity. Statin treatment effect was determined, in a nested case-control design, through logistic treatment models with 1:3 propensity matching for age, gender and ethnicity. All statistical tests were two-sided, and statistical significance was taken as p < 0.05. One hundred fifty-six (21.8%) patients had dyslipidaemia and 97% of these were on statins. Logistic treatment models showed a lower chance of ICU admission for statin users when compared to non-statin users (ATET: Coeff (risk difference): - 0.12 (- 0.23, - 0.01); p = 0.028). There were no other significant differences in other outcomes. Statin use was independently associated with lower ICU admission. This supports current practice to continue prescription of statins in COVID-19 patients.

Thrombosis Management and Challenges in COVID-19 Patients Presenting with Acute Coronary Syndromes

Thrombotic complications in patients with coronavirus disease 2019 (COVID-19) infection have been increasingly recognized, particularly those affecting the cardiovascular system. Patients with COVID-19 infection can suffer from increased coagulopathy as well as myocardial injury. In this review, we discuss these complications with special focus on management challenges in patients with acute coronary disease based on the available evidence from published literature.