Healthy farmer presenting with chest pain and bradycardia during peak COVID season

Abstract

This was a patient who got admitted with three related cardiological presentations during the same admission. Initially he presented with an Inferior ST-elevation myocardial infarction (STEMI) and bradycardia. Following primary percutaneous coronary intervention (PPCI) to the right coronary artery (RCA), he was found to be in complete heart block and new onset atrial fibrillation was noted. This case proved to be interesting and challenging at the same time in view of constantly evolving factors during the peak coronavirus disease (COVID-19) pandemic. There was a great deal of uncertainty over the course of patient's illness not only due to cardiological issues, particularly arrhythmias relating to COVID, but also due to high levels of staff illness, rapidly evolving clinical guidance and emergence of data introducing new variables to consider. The clinical team not only dealt with his initial presenting symptom (chest pain- PPCI) promptly and effectively, but also carefully evaluated his subsequent new unexpected symptoms (bradycardia- pacemaker insertion) and new onset angina (further PCI to LAD) with equal vigour and seriousness, resulting in excellent final results for all of his three conditions with complete and total resolution of all symptoms. We therefore managed to discharge him successfully in spite of unusual challenges noted due to the pandemic situation. We managed to observe highest level protective measures, preventing him from acquiring COVID whilst surrounded by COVID positive and suspected patients and staff.