Myocardial infarction with non-obstructive coronary artery in a middle-aged woman with COVID-19.

Cardiovascular involvement is commonly described in coronavirus disease 2019 (COVID-19), where myocardial injury can be caused by exacerbation of the underlying disease and de novo cardiovascular involvement, including myocarditis, stress cardiomyopathy and myocardial infarction. There was a drop in acute coronary syndrome admission rates worldwide as collateral damage of the COVID-19 pandemic as patients were reluctant to seek appropriate care. We presented a 47-year-old woman with acute heart failure and COVID-19 pneumonia. She had a history of typical prolonged chest pain 2 weeks before but no coronary risk factors. The electrocardiogram was consistent with late presentation myocardial infarction. Focused echocardiography showed severe left ventricle systolic dysfunction. She was medically treated for both pneumonia and heart failure. Coronary angiography showed no flow-limiting lesion. Cardiac magnetic resonance in the recovery phase revealed subendocardial late gadolinium enhancement in the left anterior descending territory compatible with myocardial infarction.