Severe COVID-19 post pregnancy complicated by acute thromboemboli resulting in ST-elevation myocardial infarction – A case report.

Severe COVID-19 post pregnancy complicated by acute thromboemboli resulting in ST-elevation myocardial infarction – A case report.

Publication date: Jan 17, 2024

Introduction: It has been shown that pregnancy can cause alterations in the severity of COVID-19 infection. We demonstrate an immediate post-partum patient diagnosed with severe COVID-19 and subsequently developed acute thrombosis of coronary artery. Case Summary: 35-year-old female unvaccinated for COVID-19 presented in labor and delivered on the same day. Several hours later, she was found to be in respiratory distress and tested positive for COVID-19. On day 7, computerized tomography (CT) of chest revealed bilateral pneumonia and pneumomediastinum. On day 8, she developed chest pain with electrocardiogram (EKG) showing inferior STelevations with troponin I of 0. 6 ng/mL. She was intubated for airway protection and emergent diagnostic angiogram revealed thrombus occlusion of the third right posterolateral segment that resulted in thrombolysis in myocardial infarction (TIMI) 0 flow without evidence of underlying atherosclerotic disease in the remaining vessels. Intracoronary IIb/IIIa inhibitor was administered. Arterial blood gas in the lab revealed profound hypoxia despite being on 100% inspired oxygen. Multidisciplinary decision was made to cannulate patient for venovenous extracorporeal membrane oxygenation (ECMO) to treat severe COVID-19 pneumonia. She was finally decannulated from ECMO on day 65. After prolonged hospital stay, she eventually recovered and was discharged to rehabilitation. Conclusions: The center for disease control (CDC) surveillance has reported that pregnant patients with COVID-19 are more likely to require invasive ventilation and ECMO, and die given the immunological changes during pregnancy. Hypercoagulable state caused by combination of pregnancy and COVID-19 resulting in coronary thrombosis is rarely described in literature, our case demonstrated the paucity of this phenomenon.

Concepts Keywords
Cdc coronary thrombosis
Ct COVID-19
Hours extracorporeal membrane oxygenation
Myocardial ischemic heart disease
Pneumonia pregnancy

Semantics

Type Source Name
disease MESH COVID-19
disease MESH myocardial infarction
disease VO report
disease MESH infection
disease MESH thrombosis
disease VO unvaccinated
disease MESH pneumonia
disease MESH pneumomediastinum
disease MESH chest pain
drug DRUGBANK Oxygen
disease MESH coronary thrombosis
disease MESH ischemic heart disease

Original Article

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