https://orcid.org/0000-0002-7219-5404
Dyspnoea may occasionally represent an equivalent of angina in the case of acute myocardial infarction. In the time of COVID-19, the work up of patients presenting in the emergency department (ED) for dyspnoea may often include computed tomography (CT) scan; the diagnosis of acute myocardial infarction may therefore be occasionally incidental and unconventional.
We report the case of a 46-year old hypertensive female patient admitted to the ED for suspected transitory ischaemic attack (referred dysarthria), dyspnoea, and fever 37.5°C. As this was during the time of the COVID-19 pandemic, an admission nasopharyngeal swab was performed. Admission electrocardiogram showed signs of left ventricular hypertrophy without acute ischaemia and significant ST-segment elevation (Panel A). Despite normal neurological examination without focal signs, a head and chest CT scan was performed in order to exclude neurological acute lesions and COVID-19 interstitial pneumonia. Unexpectedly, CT scan showed normal lung findings but evident hypo-enhancement of the posterior left ventricular wall (Panel B, C, red arrows). A second electrocardiogram showed evident left ventricle hypertrophy with ST-segment elevation in inferior leads (Panel D). After immediate cath lab admission, coronary angiography showed an occluded right coronary artery (Panel E, red arrow), treated with a drug-eluting stent (Panel F).
In a COVID-19 pandemic context, particular attention is often paid to respiratory symptoms and fever, while chest pain and its possible analogue are often underestimated or misinterpreted; preliminary electrocardiogram examination may be occasionally overlooked in the ED. Although the standard 12-lead electrocardiogram is considered the first-line exam for the diagnosis of acute myocardial infarction, chest CT scan may provide detailed information on the presence and the extension of acute myocardial infarction. In the time of COVID-19, diagnosis of acute myocardial infarction may occasionally occur in radiology rather than in the ED. Nasopharyngeal swab was negative for SARS-CoV-2 infection.
Conflict of interest: The authors have submitted their declaration which can be found in the article Supplementary Material online.
