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Copyright ©The Author(s) 2022.
World J Crit Care Med. May 9, 2022; 11(3): 129-138
Published online May 9, 2022. doi: 10.5492/wjccm.v11.i3.129
Table 1 Case reports of myocardial infarction with non-obstructive coronary arteries in coronavirus disease 2019
Sl. No
Ref.
Age in yr
Sex
Presenting complaint
Comorbidities
Chest imaging
ECG
Cardiac troponins
Echocardiogram
Angiogram
Other investigations
Management
Outcome
1[3]47MShortness of breath for 6 d, angina on day 2 of admittionHypertensionCT thorax: Diffuse bilateral infiltrates, ground glass opacities, crazy paving with thickened interlobular septa, and consolidation in lower lobesInferior STEMI0.012 ng/mL (Ref range: < 0.0262 ng/mL)Not reportedEmergency coronary angiography showed 30%-40% stenosis in the midportion of the left anterior descending artery. In addition to this, the left main coronary artery, left circumflex artery and right coronary artery were normal. ST segment elevation regressed in the ECG of the patient, who had no more ischemic cardiac symptoms after the interventionCTPA did not reveal any evidence of pulmonary embolism. Cardiogoniometry (a non-invasive medical tool worked with spatiotemporal vectocardiographic advancement), was performed after 24 h of the pain, it revealed septal inferior myocardial ischemia300 mg po acetylsalicylic acid, 180 mg po ticagrelor, and 4000 IU IV heparinDischarged on the eleventh day of his hospitalization in a healthy state
2[4]48FPain in her chest and left shoulder for 1 daynonenoneInverted T-waves in II, III, aVF, V4, V5, and V6Upward of 25000 pg/mL (Ref range: 0.0–51.4 pg/mL)Hypokinesis in the apical inferior segment of the left ventricleCTCA was performed to exclude a coronary origin for the complaints and for the laboratory and ECG abnormalities, which revealed no significant coronary obstructionCMR showed features of myocardial oedema restricted to the mid-ventricular to apical territory of the right coronary artery (RCA). Based on subendocardial to partially transmural late gadolinium enhancement in the mid-ventricular to apical inferior wall, an acute myocardial infarction was diagnosed. Cardiac positron emission tomography–computed tomography showed evidence of reduced metabolic activity in the area affected by the infarctionAcetylsalicylic acid, prophylactic-dose low-molecular-weight heparin, and statin. Later dual anti-platelet therapy and an angiotensin-converting-enzyme inhibitor was startedDischarged. Follow-up echocardiography 2 d after discharge revealed a normal ejection fraction (58%) despite persistent inferior apical akinesia
3[5]86MCough and shortness of breath which progressed to acute hypoxemic respiratory failure requiring intubationChest X-ray: bilateral infiltrates at the bases with no other abnormalities3–4 mm ST-segment elevations in leads V2 and V34.82 ng/mL (Ref range: < 0.10 ng/mLEjection fraction of 50%–55%, no significant regional wall motion abnormalities, and no signs of cardiac tamponadeNo significant coronary artery diseaseAdmitted to the intensive care unit, requiring mechanical ventilation and vasopressor supportRespiratory status worsened and he required increased oxygen and positive end-expiratory pressure, renal function worsened, as did lymphopenia and inflammatory biomarker abnormalities. Died on day 8
4[6]61MShortness of breath, respiratory failure requiring intubationHypertension, diabetes mellitus2 mm of antero-lateral ST-elevation without reciprocal depression6283 ng/L (Ref range: < 40 ng/L)Moderate left ventricular systolic dysfunctionNo luminal stenosis or thrombosis, with preserved TIMI 3 flows in all coronary arteriesLeft ventriculography: Mild apical hypokinesisLoading dose of ticagrelor and IV heparinOn day 13, he was anuric and CVVH was started. Continued to worsen and died
5[6]59FFound minimally responsive on the ground. Intubated by paramedicsHypertension, COPDCT thorax: Bilateral lower lung lobe infiltrates and pulmonary oedema with moderate calcification in the mid-left anterior descending arteryST-segment elevations in V1–V4 and reciprocal ST-depressions in leads II, III, and aVF2390 ng/Lreduced left ventricular ejection fraction of 40% with antero-apical wall hypokinesisModerate diffuse atherosclerotic disease was observed in the left system with no significant luminal obstruction elsewhereNot specifiedExtubated on Day 3. Discharged home subsequently
6[6]69Facute onset chest tightness and dyspneaNon-ischemic heart failure with reduced ejection. Implantable cardioverter-defibrillator was placed in 2004. Motor neurone disease, diagnosed 4 yr previouslyChest X-ray: Bilateral infiltratesLeft bundle branch block. On day 3 progressive dynamic concordant ST-elevation in V1–V2 and ST-depression in V3–V5504 ng/LImpaired left ventricular function which was similar to baselineNo obstructive atheroma or thrombusLoading dose dual antiplatelets, therapeutic low molecular weight heparin, high-dose IV diuretics, and IV nitratesThe patient died on Day 7 of admission
7[7]51MLeft sided chest pain, diaphoresis, syncopeHypertension and hypercholesterolemiaChest X-ray: Bilateral interstitial prominenceCT chest: perihilar ground glass opacities, thickening of interlobular septa, and minimal bilateral pleural effusions, interpreted as consistent with congestive heart failure3.5 mm ST elevation in I and avL, 5 mm isolated ST elevation in lead V2, with deep reciprocal depressions in III, avF and avRNot reportedPreserved left ventricular ejection fraction (LVEF) of 55% and anteroapical hypokinesis on ventriculographyPatent coronary arteriesAdmitted to Cardiac Intensive Care Unit and started on supportive measures. Treated with lopinavir/ritonavir 400 mg/100 mg tablet every 12 h for 4 d and hydroxychloroquine 500 mg every 12 h, then hydroxychloroquine alone 400 mg dailyThe patient recovered and was discharged home on day 26 on aspirin, statin and metoprolol
8[8]71FChest-painHypertension, past STEMIChest X-ray: No pulmonary opacitiesST-segment elevation in inferior leads, and ST depression, and inverted T waves in V1-3NegativePreserved left ventricular ejection fraction of 50% with inferior and septal hypokinesisNon-obstructive coronary artery diseaseLoading dose of ticagrelor and unfractionated heparinDischarged