Ratna M TambaUniversitas Sumatera Utara, Indonesia
Title: A Suspected COVID-19-associated Myocarditis Case Mimicking Life-threatening STEMI: a Shark Fin Appearance
Background: Some cases of myocarditis have been reported associated to Covid-19. The presence of pro-inflammatory response from immune cells suggested occurs by binding to membrane protein ACE-2 leading to myocardial damage.
Case Description: A 51-years-old woman was reffered from a non-PCI-capable hospital with chest pain and progressive heavy breath with history of fever two days ago. She was diagnosed with anterior STEMI and cardiogenic shock on vassopressors. After got blood thinner and DAPT, she was reffered to underwent PCI. Her ECG showed shark fin appearance suggestive life-threatening STEMI. Her rapid test for covid-19 are non-reaktif for both IgM and IgG. Her NCCT-thorax showed ground glass opacity in both lungs. Her laboratories finding showed elevated inflammatory markers and elevated cardiac biomarker. We took her naso-oro-pharingeal swab in the same day and process her with emergency PCI. Surprisingly, her angiography showed normal coronary artery without any significant stenosis. There was no SARS-CoV-2 detected. Unfortunately, the patient was discharged without doctor’s consent, so we can not process the second swab and echocardiogarphy to evaluate the function of myocardium.
Discussion: In myocarditis, patient can mimicking the same symptoms as STEMI such as chest pain and heavy breath with elevated cardiac biomarker, but the ecg usually show widespread concave ST-elevation with PR-segment depression. Shark fin appearance is usually seen in life-threatening STEMI. In our patient, the NCCT-thorax showed GGO suggested COVID-19 involvement. But, the swab was negative for SARS-CoV-2.
Conclusion: We still can not confirmed this case if it is true myocarditis-associated covid-19 and how was the involvement of the myocardium creating a shark fin mimicking life-threatening STEMI.
To be updated soon...