Wolsky Ryan M, Bateman Cinthia T
Internal Medicine, Advocate Christ Medical Center, Oak Lawn, USA.
Cardiovascular Medicine, South Denver Cardiology Associates, Littleton, USA.
Cureus. 2022 Jul 19;14(7):e27026. doi: 10.7759/cureus.27026. eCollection 2022 Jul.
A well-known complication of COVID-19 is hypercoagulability in both the venous and arterial circulation. Most cases of hypercoagulability-related complications have been described in hospitalized patients with severe diseases and multiple comorbidities. However, this report outlines a case of myocardial infarction in a young patient with no prior medical history after only a mild course of COVID-19. His symptoms resolved after a mild 12-day illness course that did not require hospitalization or supplemental oxygen. Three days after the resolution of his symptoms (15 days after testing positive), the patient presented to the emergency department with crushing chest pain and was found to have complete thrombotic occlusion of his left anterior descending artery. Hypercoagulability in COVID-19 patients is suspected to be caused by vascular endothelial injury and cytokine storm. This has been demonstrated in the arterial and venous circulation, as seen in histopathology samples as well as increased incidence of acute limb ischemia in COVID-19 patients. Additionally, COVID-19 is known to have myocardial involvement, as demonstrated by elevations in cardiac enzymes and cardiac imaging findings that may persist months after initial infection. Those affected by COVID-19 may have dangerous cardiovascular complications that persist after the resolution of the acute viral illness.
新型冠状病毒肺炎(COVID-19)的一个众所周知的并发症是动静脉循环中的高凝状态。大多数与高凝状态相关的并发症病例都在患有严重疾病和多种合并症的住院患者中有所描述。然而,本报告概述了一名年轻患者的心肌梗死病例,该患者在经历了轻度的COVID-19病程后,此前并无病史。他在经历了12天的轻度病程(无需住院或补充氧气)后症状缓解。症状缓解三天后(检测呈阳性15天后),该患者因压榨性胸痛前往急诊科就诊,结果发现其左前降支动脉完全血栓闭塞。COVID-19患者的高凝状态被怀疑是由血管内皮损伤和细胞因子风暴引起的。这在动静脉循环中已得到证实,如组织病理学样本所示,以及COVID-19患者急性肢体缺血发生率的增加。此外,已知COVID-19会累及心肌,如心肌酶升高和心脏影像学检查结果所示,这些表现可能在初次感染数月后仍持续存在。感染COVID-19的患者可能会出现危险的心血管并发症,这些并发症在急性病毒感染消退后仍会持续存在。