ST Elevation in the COVID-19 Era: A Diagnostic Challenge

Ehrman, Robert R.; Brennan, Erin E.; Creighton, Terrence; Ottenhoff, Jakob; Favot, Mark J.

Abstract Background SARS-CoV-2 induces a marked pro-thrombotic state with varied clinical presentations, including acute coronary artery occlusions leading to ST-elevation myocardial infarction (STEMI). However, while STEMI on ECG is not always associated with acute coronary occlusion, this diagnostic uncertainty should not delay cardiac catheterization. Case Report: We present two cases of patients with COVID-19 that presented with STEMI on ECG. While both patients underwent cardiac catheterization, a delay in time to intervention in the patient found to have acute coronary artery occlusion may have contributed to a poor outcome. Why Should an Emergency Physician be Aware of This? These cases highlight the fact that while not all COVID-19 patients with STEMI on ECG will have acute coronary artery occlusions, there is continued need for prompt PCI during the SARS-CoV-2 pandemic.