(Source: The New England Medical Journal, April 19, 2020)

 

ST-segment elevation was observed in patients affected with Covid-19 in New York City hospitals. These cases were described in the New England Journal of Medicine published on April 17, 2020.

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In this case series, ST-segment elevation was observed on electrocardiography (ECG) for 18 patients with confirmed COVID-19, suggesting heart attack. The median age was 63, and 83% were male; 50% were Hispanic, 22% white, 17% Asian, and 11% black. Most patients had underlying cardiac risk factors. 10 patients had ST-segment elevation at hospital presentation, while 8 patients displayed it later, 6 days after hospitalization. Only 33% presented with chest pain; 83% had respiratory symptoms (cough, shortness of breath, or respiratory distress). Out of 18 patients, 10 had normal wall motion (nonobstructive disease) on ECG were likely to have diffuse ST-segment elevation, 9 of whom died in the hospital. The other 8 patients had a heart attack and 4 of them died.

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Since this case series is a small and early picture of COVID-19 patients with ST-segment elevation, there several key factors considered for diagnosis and management. In conclusion, COVID-19 patients with ST-segment elevation are more likely to be male and Hispanic, have a high prevalence of the nonobstructive disease, and a poor prognosis. Myocardial injury in patients with COVID-19 could be due to many causes namely plaque rupture, cytokine storm, hypoxic injury, coronary spasm, microthrombi, or direct endothelial or vascular injury. To improve outcomes, studies suggest optimal therapies for myocardial injury in COVID-19 patients.