Acute coronary syndrome and ischemic stroke in the course of COVID-19 infection

Abstract

The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-Cov-2) pandemic has spread rapidly worldwide with 314 million infected and 5 million deceased worldwide (as of December 2021). SARS-Cov-2 has been shown to not only cause viral pneumonia, but also to lead to serious effects on the cardiovascular system. It has been proven that COVID-19 can be complicated by the Acute Coronary Syndrome through plaque rupture, vasospasm or microthrombi due to systemic inflammation or cytokine storm. An additional role is played by the hyperimmune response as well as the endothelial dysfunction, which contribute to the hypercoagulable state. Тhere is a strong possibility that the high inflammatory load is the cause of de novo coronary lesions. We present a clinical case of a 53-year-old man presenting with toxico-infectious syndrome, angina and dyspnea. Conducted paraclinical and clinical studies showed acut coronary syndrome without ST-elevation, left ventricular thrombosis, active SARS-CoV-2 infection and bilateral interstitial pneumonia. The patient was treated with percutaneous coronary intervention of LAD with drug-eluting stent, anticoagulant therapy, dual antiplatelet and anti-inflamatory therapy, beta blocker and ACE-inhibitor. On the 4th day of hospitalization the patient realized Left Middle Cerebral Artery Stroke. Our clinical case demonstrates unique prothromobotic properties of SARS-CoV-2, due to different mechanisms and complicated by thromboembolic events.