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| 55 year old, male | | 55 year old, male admitted due | ||
to cough and | to fever, cough and shortness of breath | ||
with suspected [[COVID-19]]. | with suspected [[COVID-19]]. | ||
| | | Developed [[chest pain]] 48 hrs after admission | ||
[[chest pain]] | |||
|[[Peripheral arterial disease|Peripheral artery disease]] | |[[Peripheral arterial disease|Peripheral artery disease]] | ||
| | | | ||
* [[The electrocardiogram|EKG]]: Inverted T waves | * [[The electrocardiogram|EKG]]: Inferior leads shows Inverted T waves. | ||
*[[Troponin I]] was elevated {Hs-TnI was at 355 ng/l, then 570 ng/l | *[[Troponin I]] was elevated {Hs-TnI was at 355 ng/l, then 570 ng/l | ||
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* [[Transthoracic echocardiography]]:Left ventricular [[ejection fraction]] | * [[Transthoracic echocardiography]]:Left ventricular [[ejection fraction]] | ||
60% | 60% wall motion had no abnormalities, absence of [[Diastole|diastolic]] dysfunction, | ||
and | and presence of mild [[mitral regurgitation]] | ||
* [[Coronary angiography|Coronary angiogram]] : Chronic total [[occlusion]] of the posterior | * [[Coronary angiography|Coronary angiogram]] : Chronic total [[occlusion]] of the posterior | ||
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descending artery with [[epicardial]] collateral from the left anterior descending artery. | descending artery with [[epicardial]] collateral from the left anterior descending artery. | ||
In the mid-right coronary artery, a spontaneous dissecting coronary [[hematoma]] | In the mid-right coronary artery, an intimal tear is present with a spontaneous dissecting coronary [[hematoma]] | ||
* Optical coherence tomography ([[Cardiac Optical Coherence Tomography (OCT)|OCT]]): spontaneous dissecting coronary [[hematoma]] with an intimal rupture of right coronary artery | * Optical coherence tomography ([[Cardiac Optical Coherence Tomography (OCT)|OCT]]): spontaneous dissecting coronary [[hematoma]] with an intimal rupture of right coronary artery | ||
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*[[Aspirin]], [[Statins]], and [[Beta blockers|Beta-blockers]]. | *[[Aspirin]], [[Statins]], and [[Beta blockers|Beta-blockers]]. | ||
* | * Coronary angiogram was planned. | ||
|- | |- | ||
|70-year-old, male | |70-year-old, male | ||
|Severe , persistent chest pain ( 8/10), which started 3 hrs before admission | |Severe , persistent chest pain ( 8/10), which started 3 hrs before admission | ||
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* EKG: | * EKG: [[Precordium|precordial]] leads shows new ST-T abnormalities which was not present previously. | ||
[[Image:70yr.png|thumb|700px|right|frame|ST-T abnormalities in the precordial leads.]]<ref name="SeresiniAlbiero2020">{{cite journal|last1=Seresini|first1=Giuseppe|last2=Albiero|first2=Remo|last3=Liga|first3=Riccardo|last4=Camm|first4=Christian Fielder|last5=Liga|first5=Riccardo|last6=Camm|first6=Christian Fielder|last7=Thomson|first7=Ross|title=Atherosclerotic spontaneous coronary artery dissection (A-SCAD) in a patient with COVID-19: case report and possible mechanisms|journal=European Heart Journal - Case Reports|year=2020|issn=2514-2119|doi=10.1093/ehjcr/ytaa133}}</ref> | [[Image:70yr.png|thumb|700px|right|frame|ST-T abnormalities in the precordial leads.]]<ref name="SeresiniAlbiero2020">{{cite journal|last1=Seresini|first1=Giuseppe|last2=Albiero|first2=Remo|last3=Liga|first3=Riccardo|last4=Camm|first4=Christian Fielder|last5=Liga|first5=Riccardo|last6=Camm|first6=Christian Fielder|last7=Thomson|first7=Ross|title=Atherosclerotic spontaneous coronary artery dissection (A-SCAD) in a patient with COVID-19: case report and possible mechanisms|journal=European Heart Journal - Case Reports|year=2020|issn=2514-2119|doi=10.1093/ehjcr/ytaa133}}</ref> | ||
* [[Echocardiography|Echocardiogram]]: Left ventricular [[ejection fraction]] 40–45% with [[akinesia]] in the LCx territory (old) and a severe [[Hypokinesia|hypokinesis]] in the left anterior ascending (LAD) | * [[Echocardiography|Echocardiogram]]: Left ventricular [[ejection fraction]] 40–45% with [[akinesia]] in the LCx territory (old) and a severe [[Hypokinesia|hypokinesis]] in the left anterior ascending (LAD). | ||
* [[Coronary angiography|Coronary angiogram]]: moderate in-stent restenosis on LCx-OM and a moderate right coronary artery (RCA) stenosis | * [[Coronary angiography|Coronary angiogram]]: moderate in-stent restenosis present on LCx-OM and a moderate right coronary artery (RCA) stenosis | ||
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|48‐year‐old, female | |48‐year‐old, female | ||
|History of severe chest pain that awoke her from sleep,9/10,severe,retrosternal tightness,pain radiates to neck and both arms. | |||
|History of severe chest pain that awoke her from sleep,9/10,severe,retrosternal tightness | |||
|[[Migraine]] and [[Hyperlipidemia]] | |[[Migraine]] and [[Hyperlipidemia]] | ||
| | | | ||
* | * Elevated Troponin I from <0.01 to 0.5 ng/ml (Normal: <0.80 ng/ml) | ||
* [[Electrocardiogram]]: No | * [[Electrocardiogram]]: No changes or signs of ischemia | ||
* [[Echocardiogram|Transthoracic echocardiogram]] : Left ventricular [[ejection fraction]] 45–50% and | * [[Echocardiogram|Transthoracic echocardiogram]] : Left ventricular [[ejection fraction]] 45–50% and distal anteroseptal and apical segments shows akinesia | ||
* [[Angiogram|Computed tomography coronary angiogram]]: | * [[Angiogram|Computed tomography coronary angiogram]]:mid‐to‐distal LAD dissected | ||
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|} | |} | ||
<references /> | |||
Revision as of 16:45, 20 July 2020
- Here is a table presenting symptoms of the reported cases:
| Patient | Symptoms | Past medical history and risk factors | Laboratory findings | Treatment |
|---|---|---|---|---|
| 55 year old, male admitted due
to fever, cough and shortness of breath with suspected COVID-19. |
Developed chest pain 48 hrs after admission | Peripheral artery disease |
3 h later (normal values <7 ng/l)}
60% wall motion had no abnormalities, absence of diastolic dysfunction, and presence of mild mitral regurgitation
descending artery with epicardial collateral from the left anterior descending artery. In the mid-right coronary artery, an intimal tear is present with a spontaneous dissecting coronary hematoma |
|
| 70-year-old, male | Severe , persistent chest pain ( 8/10), which started 3 hrs before admission | Smoking, Hypertension, and Type 2 diabetes,
H/O percutaneous coronary intervention (PCI) with implantation of a drug-eluting stent (DES) |
|
|
| 48‐year‐old, female | History of severe chest pain that awoke her from sleep,9/10,severe,retrosternal tightness,pain radiates to neck and both arms. | Migraine and Hyperlipidemia |
|
|
- ↑ Seresini, Giuseppe; Albiero, Remo; Liga, Riccardo; Camm, Christian Fielder; Liga, Riccardo; Camm, Christian Fielder; Thomson, Ross (2020). "Atherosclerotic spontaneous coronary artery dissection (A-SCAD) in a patient with COVID-19: case report and possible mechanisms". European Heart Journal - Case Reports. doi:10.1093/ehjcr/ytaa133. ISSN 2514-2119.