A Complicated Case of COVID-19-Induced Inferolateral Wall Myocardial Infarction Successfully Treated With Streptokinase

Abstract

The treatment of myocardial infarction (MI) in coronavirus disease 2019 (COVID-19)-positive patients is both controversial and challenging, particularly in a healthcare setup unable to fulfill COVID-19 protocols. In this report, we describe a case of a COVID-19-positive patient admitted with COVID-19 pneumonia treated symptomatically with a non-rebreathing mask, dexamethasone, remdesivir, and low-molecularweight heparin (LMWH). On day two of the hospital stay, the patient developed inferolateral wall myocardial infarction (MI) without hemodynamic instability. He was treated successfully with thrombolytic (streptokinase) with no severe complications. However, his hospital stay was further complicated by decreasing oxygen saturation and rising inflammatory markers including procalcitonin and IL-6, suggesting superimposed bacterial infection. Thereafter, he was placed on BiPAP oxygen, and aggressive antibiotic therapy including tigecycline along with clindamycin and moxifloxacin was initiated. He showed gradual daily improvements and was discharged after a prolonged hospital stay. To decrease the exposure and spread of COVID-19 infection among the healthcare workers, when there is a deficiency in medical staff, and no negative-pressure catheterization laboratory, thrombolytic can be used for treatment in low-risk, hemodynamically stable MI during this pandemic. However, this needs further research.

Simultaneous Acute Portal Vein Thrombosis and ST Elevation Myocardial Infarction in a COVID-19 Patient – Case Report

“…A different study has reported a Covid-19 case with inferolateral ST-elevation MI while the patient was infected with Covid-19 (similar to our case) but with pulmonary involvement and a decreased O2 saturation (unlike our case) [5]. Generally, thrombolytic therapy and conservative treatment are the priority choices for Covid-19 positive patients with ST-elevation MI and NonST-elevation MI, respectively.…”

“…Hence, we choose conservative treatment for our patient. Unlike the study [5], no Streptokinase or any other thrombolytic medication were prescribed for our patient due to recovering chest pain and improving evolving MI. Also, no coronary angiography has been performed for the patient in Ref.…”

“…An acute MI had occurred to the patient in Ref. [5] during hospitalization (2-3 days after admission), making the patient eligible for thrombolytic therapy. This is unlike our patient, who had experienced MI during their quarantine period and was referred to the hospital with a relatively long delay.…”

“…Also, no coronary angiography has been performed for the patient in Ref. [5] due to the patient's Covid-19 infectious phase with much higher contagious risks. In contrast, in our case, we were able to perform angiography because the patient was at their final days of infection, closer to the end of quarantine.…”

Our Dedicated Effort to Save a COVID-19 Confirmed Patient with Myocardial Infarction

“…Some cases about COVID-19 patients with AMI have been reported in the literature. 1 2 3 This is the first case of a COVID-19 confirmed patient with AMI in our tertiary center. Despite the time-sensitive nature of AMI, a treatment delay between diagnosis and procedure may occur among COVID-19 patients.…”