Case of development of circular myocardial infarction with rupture of the left ventricular wall after SARS-CoV-2 infection

• Alpidovskaya O.V.

Abstract

The article demonstrates a case of development of circular myocardial infarction after infection with SARS-CoV-2. The patient suffered sudden death with circulatory arrest, which was caused by a rupture of the left ventricular (LV) wall and hemopericardium.

Clinical case. Patient 34 years old on May 20, 2023, was hospitalized with a diagnosis of a severe new coronavirus infection. Acute circular myocardial infarction. Complaints at admission: sharp pressing pains in the region of the heart. From the anamnesis of the disease: she fell ill three weeks ago, before the previous hospitalization, she noted an increase in body temperature to 37.2 °С, she took antipyretic drugs. Within a few days the body temperature reached – 38.5 °С. In the evening – 05/19/2023, the patient noted transient discomfort behind the sternum at rest, 05/20/2023 – the patient’s condition worsened, pressing pains behind the sternum appeared, called an ambulance. According to the electrocardiogram (ECG): an increase in the Q wave in leads II, III, aVF and V₂–V₆. In the same leads, there was a rise in the ST segment and inversion of the T wave. Blood pressure (BP) – 100/75 mm Hg. The assessment of the state on the NEWS2 scale was 9 points. PCR test for coronavirus was positive. Computed tomography (CT) of the chest cavity: CT signs of viral interstitial pneumonia. CT-3 (71% lung tissue damage). Despite treatment, the patient died. At autopsy, signs of viral interstitial pneumonia are determined. In the heart – necrotic cardiomyocytes, accumulation of blood between myocytes. A slit-like irregularly shaped defect is determined, with a violation of the integrity of the myocardium in the zones of the lower and anterior – lateral wall of the left ventricle.

Conclusion. In this case, circular MI developed in a young patient without comorbidity after SARS-CoV-2 infection. There were severe complications – ruptures of the lower and anterior – lateral wall of the left ventricle and hemopericardium.

Keywords:COVID-19; thrombosis; coronary arteries; left ventricular wall rupture; hemopericardium

References

1.     Goshua G., Pine A.B., Meizlish M.L., et al. Endotheliopathy in COVID-19-associated coagulopathy: evidence from a single-centre, cross-sectional study. Lancet Haematol. 2020; 7 (8): e575–82. DOI: https://doi.org/10.1016/S2352-3026(20)30216-7  PMID: 32619411.

2.     Babaev M.A., Petrushin M.A., Dubrovin I.A., Kostritsa N.S., Eremenko A.A. Acute myocardial injury in coronavirus disease 2019 (COVID-19) (case report). Clinical and Experimental Surgery. Petrovsky Journal. 2020; 8 (3): 87–94. DOI: https://doi.org/10.33029/2308-1198-2020-8-3-87-94  (in Russian)

3.     Shatohin Yu.V., Snezhko I.V., Ryabikina E.V. Violation of hemostasis in coronavirus infection. Yuzhno-Rossiyskiy zhurnal terapevticheskoy praktiki [South-Russian Journal of Therapeutic Practice]. 2021; 2 (2): 6–15. DOI: https://doi.org/10.21886/2712-8156-2021-2-2-6-15  (in Russian)

4.     Guo T., Fan Y., Chen M., Wu X., Zhang L., He T., et al. Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19). JAMA Cardiol. 2020; 5 (7): 811–8.

5.     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): 802–10.

6.     Bansal M. Cardiovascular disease and COVID-19. Diabetes Metab Syndr. 2020; 14 (3): 247–50. DOI: https://doi.org/10.1016/j.dsx.2020.03.013  PMID: 32247212.

7.     Tajbakhsh A., Hayat S.M. G., Taghizadeh H., Akbari A., Inabadi M., Savardashtaki A., et al. COVID-19 and cardiac injury: clinical manifestations, biomarkers, mechanisms, diagnosis, treatment, and follow up. Expert Rev Anti Infect Ther. 2021; 19 (3): 345–57. DOI: https://doi.org/10.1080/14787210.2020.1822737  PMID: 32921216.

8.     Tavazzi G., Pellegrini C., Maurelli M., Belliato M., Sciutti F., Bottazzi A., et al. Myocardial localization of coronavirus in COVID-19 cardiogenic shock. Eur J Heart Fail. 2020; 22 (5): 911–5. DOI: https://doi.org/10.1002/ejhf.1828  PMID: 32275347.

9.     Guzik T.J., Mohiddin S.A., Dimarco A., Patel V., Savvatis K., Marelli-Berg F.M., et al. COVID-19 and the cardiovascular system: implications for risk assessment, diagnosis, and treatment options. Cardiovasc Res. 2020; 116 (10): 1666–87. DOI: https://doi.org/10.1093/cvr/cvaa106  PMID: 32352535.

10. Vorob’eva O.V., Lastochkin A.V. Organ changes in COVID-19 patients with essential hypertension and aortic aneurysm: clinical observation. Profilakticheskaya meditsina [Preventive Medicine]. 2021; 24 (4): 41–4. (in Russian)

11. Vorob’eva O.V., Romanova L.P. A case of abscessed pneumonia due to COVID-19 infection in a young patient. Infektsiya i immunitet [Infection and Immunity]. 2022; 12 (4): 779–83. DOI: https://doi.org/10.15789/2220-7619-ACO-1582  (in Russian)

All articles in our journal are distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0 license)