CORONARY - Cardiac Surgery/Hybrid Revascularization
Multiple Complication After Delayed Treated STEMI in COVID-19 Threatening
Tung-Lin Tsui1, Wei-Wen Lin2, Chen-Yen Chien3
Camillian Saint Mary's Hospital Luodong, Taiwan1, Taiwan Adventist Hospital, Taiwan2, Mackay Memorial Hospital, Taiwan3,
Patient initials or Identifier Number
Relevant Clinical History and Physical Exam
This is a 56-year-old gentleman who experienced severe chest tightness with cold sweating and mild fever since the morning. And he visited a local hospital for help. The initial EKG showed inferior lead ST elevation and ST depression over precordial leads. For further treatment, he was transferred to a regional hospital for primary PCI. CXR showed severe left lung infiltration.
Relevant Test Results Prior to Catheterization
However, due to the contact history of foreigners come from China and Japan, he was admitted to an isolation room and primary PCI was held. Instead of primary PCI, systemic urokinase infusion was arranged with 1500000u/day. The result of COVID-19 test showed negative 72 hours later, and the CXR showed no improvement. Leukocytosis with elevated CRP level was found, with acute kidney injury status.
Relevant Catheterization Findings
CAG was done and which showed a large thrombus over middle to distal RCA with TIMI 1-2 flow and critical stenosis over middle to distal LCX.
Some atherosclerotic lesion was noted over LAD but no significant stenosis was found, and no collateral circulation to RCA.
The most suggested management for STEMI was primary coronary intervention, besides, after successful revascularization for culprit lesion, if critical stenosis which may have potency to become acute infarction, we can do coronary intervention for the lesion as the same operation. However, because of the threatening of COVID-19, some primary coronary intervention may be held, which may induce more myocardial damage, and cause conduction system defect or delayed papillary muscle rupture. We suggested that if conduction system defect was noted, repeated echocardiography was necessary for heart structure and function study.