COVID-19 and spontaneous coronary artery dissection: causality?

Abstract

To the Editor, The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of the coronavirus disease 2019 (COVID-19) and is responsible for the current global outbreak. Although COVID-19 causes viral pneumonia mainly, alarms have gone off about its potential to damage the cardiovascular system with myocardial injury as a risk factor for mortality. Several are the potential causes of COVID-19 related myocardial injury including type I and type II myocardial infarction.1 This is the case report of an apparent spontaneous coronary artery dissection (SCAD) in a patient with COVID-19 (informed consent obtained) followed by a systematic review of the medical literature available. This is the case of a 40-year-old male without any known past medical history or cardiovascular risk factors who was admitted to our tertiary hospital with fever and cough. The patient tested positive in the reverse transcriptase-polymerase chain reaction test for SARS-CoV-2 infection, and the chest x-ray performed showed bilateral opacities (figure 1A). The patient was admitted to the intensive care unit due to a rapidly deteriorating clinical course within the first 72 hours despite initial supportive therapy that required early intubation. The laboratory work showed severe lymphopenia (0.5 × 103/L), troponin-T levels of 42 ng/dL, D-dimer levels...