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Cardiac Tamponade in a Patient With Myocardial Infarction and COVID-19: Electron Microscopy.

ABSTRACT: We present the case of a patient with myocardial infarction and COVID-19 disease who developed hemorrhagic pericardial effusion and cardiac tamponade. The differential diagnosis included post-infarction pericarditis and mechanical complications, thrombolysis, Dressler syndrome, and viral pericarditis. The histopathologic examination of the pericardial tissue sample and electron microscopic examination established the diagnosis. (Level of Difficulty: Advanced.).

SUBMITTER: Garcia-Cruz E

PROVIDER: S-EPMC7402088 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Cardiac Tamponade in a Patient With Myocardial Infarction and COVID-19: Electron Microscopy.

García-Cruz Edgar E Manzur-Sandoval Daniel D Lazcano-Díaz Emmanuel Adrián EA Soria-Castro Elizabeth E Jiménez-Becerra Silvia S

JACC. Case reports 20200804 12

We present the case of a patient with myocardial infarction and COVID-19 disease who developed hemorrhagic pericardial effusion and cardiac tamponade. The differential diagnosis included post-infarction pericarditis and mechanical complications, thrombolysis, Dressler syndrome, and viral pericarditis. The histopathologic examination of the pericardial tissue sample and electron microscopic examination established the diagnosis. (<b>Level of Difficulty: Advanced.</b>). ...[more]

PMID: 32838332

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Project description:BackgroundCoronary vasospasm is a rare cause of ST-segment elevation myocardial infarction (STEMI) and can be precipitated by numerous inciting factors including endogenous catecholamines. Differentiating coronary vasospasm from an acute atherothrombotic event is diagnostically challenging and requires a careful clinical history combined with electrocardiographic and angiographic abnormalities to make the diagnosis and guide therapy.Case summaryWe report a case of cardiogenic shock secondary to cardiac tamponade leading to an endogenous catecholamine surge resulting in profound arterial vasospasm and STEMI. The patient presented with chest pain and inferior ST segment elevations prompting emergent coronary angiography, demonstrating subtotal occlusion of the right coronary artery, severe proximal left anterior descending coronary artery stenosis, and diffusely stenosed aortoiliac vessels. Emergent transthoracic echocardiogram revealed a large pericardial effusion and hemodynamics consistent with cardiac tamponade. Pericardiocentesis resulted in dramatic hemodynamic improvement with immediate normalization of ST segments. Repeat coronary angiography performed one day later showed no angiographically significant coronary or peripheral arterial stenosis.DiscussionThis is the first reported case of simultaneous coronary and peripheral arterial vasospasm presenting as inferior STEMI caused by endogenous catecholamines from cardiac tamponade. Several clues suggest coronary vasospasm including the discordant electrocardiography (ECG) and coronary angiographic findings as well as diffusely stenosed aortoiliac vessels. Diffuse vasospasm was confirmed when repeat angiography performed after pericardiocentesis demonstrated angiographic resolution of coronary and peripheral arterial stenosis. Though rare, circulating endogenous catecholamines resulting in diffuse coronary vasospasm may present as STEMI and should be considered based on the clinical history, ECG findings, and coronary angiography.

Dataset Information

Cardiac Tamponade in a Patient With Myocardial Infarction and COVID-19: Electron Microscopy.

Publications

Cardiac Tamponade in a Patient With Myocardial Infarction and COVID-19: Electron Microscopy.

Similar Datasets

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