Tan Joo Hor, Tong Jieli, Ho Hee Hwa
Department of Cardiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng Hospital, Singapore 308433, Singapore.
Eur Heart J Case Rep. 2020 Dec 20;5(2):ytaa506. doi: 10.1093/ehjcr/ytaa506. eCollection 2021 Feb.
The World Health Organization declared coronavirus disease 2019 (COVID-19) a global pandemic on 11 March 2020. We report a patient with acute myocardial infarction (AMI) who presented late due to fears of contracting COVID-19.
A 65-year-old man with a history of hypertension presented late to the emergency department (ED) with AMI. He gave a 2-month history of exertional angina but avoided seeking medical consult due to fears of contracting COVID-19. On the day of admission, he had 4 h of severe chest pain before presenting to the ED. He was hypotensive and tachycardic on arrival. Electrocardiogram showed inferolateral ST-elevation myocardial infarction. Chest radiograph revealed widened superior mediastinum and bedside echocardiogram revealed inferoseptal and inferolateral hypokinesia with features of cardiac tamponade. An urgent computed tomography aortogram showed possible left ventricular (LV) wall perforation with resulting haemopericardium and cardiac tamponade. Subsequent coronary angiogram showed 100% occlusion of mid left circumflex artery and a contained LV wall rupture was confirmed with LV ventriculogram. He was transferred to a tertiary centre and underwent successful emergency surgical repair.
Our index case demonstrates the impact of the COVID-19 pandemic on health seeking behaviour due to fears of contracting COVID-19 and the ensuing impact of delayed medical intervention. Cardiologists worldwide are seeing an alarming rate of rare complications of AMI in patients who present late. Physicians need to be aware of this phenomenon and have an active role to play in public education.
世界卫生组织于2020年3月11日宣布2019冠状病毒病（COVID-19）为全球大流行病。我们报告了一名因担心感染COVID-19而延迟就诊的急性心肌梗死（AMI）患者。
一名65岁有高血压病史的男性因AMI延迟就诊于急诊科。他有2个月的劳力性心绞痛病史，但因担心感染COVID-19而未寻求医疗咨询。入院当天，他在前往急诊科之前有4小时的严重胸痛。到达时他血压低且心动过速。心电图显示下侧壁ST段抬高型心肌梗死。胸部X线片显示上纵隔增宽，床边超声心动图显示下间隔和下侧壁运动减弱，伴有心脏压塞的特征。紧急计算机断层扫描主动脉造影显示可能存在左心室（LV）壁穿孔，导致心包积血和心脏压塞。随后的冠状动脉造影显示左回旋支中段100%闭塞，左心室造影证实存在局限性LV壁破裂。他被转至三级中心并接受了成功的急诊手术修复。
我们的索引病例显示了COVID-19大流行因担心感染COVID-19对就医行为的影响，以及延迟医疗干预的后续影响。世界各地的心脏病专家发现，延迟就诊患者中AMI罕见并发症的发生率惊人。医生需要意识到这一现象，并在公众教育中发挥积极作用。
