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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In December 2019&#44; in the Chinese city of Wuhan&#44; Hubei province&#44; a new pneumonia outbreak emerged&#44; caused by the SARS-CoV-2 virus &#40;severe acute respiratory syndrome coronavirus 2&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> The disease&#44; known as COVID-19 &#40;coronavirus disease 2019&#41;&#44; quickly spread to the rest of the world&#44; prompting the World Health Organization to declare a global pandemic on March 12&#44; 2020&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Case series reported in China suggest that patients with cardiovascular disease are at higher risk for developing COVID-19 and have more severe complications and worse outcomes&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#8211;3</span></a> Furthermore&#44; SARS-CoV-2 infection appears to lead to acute myocardial injury&#44; myocarditis and heart failure&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">3&#44;4</span></a> Preliminary data from Italy describe clinical presentations suggestive of acute coronary syndrome&#44; with ischemic electrical and echocardiographic changes&#44; without obstructive coronary artery disease in most patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">5&#44;6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">We present the case of a 62-year-old woman with multiple cardiovascular risk factors&#44; including hypertension&#44; dyslipidemia&#44; type 2 diabetes and previous smoking&#44; previously followed for ischemic cardiomyopathy&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In 2017&#44; the patient was admitted with acute myocardial infarction of the lateral wall and underwent emergent coronary angiography that showed total occlusion on the mid left circumflex coronary artery&#46; Angioplasty was performed and a drug-eluting stent &#40;2&#46;0 mm&#215;15 mm Resolute Onyx&#41; was implanted&#46; Her clinical course was favorable&#44; with no pathological Q waves or major ST-T changes on the electrocardiogram &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#44; normal biventricular systolic function and akinesia in the left ventricular posterior wall&#46; During an irregular cardiology follow-up of one year&#44; she had no cardiovascular symptoms&#59; two years after the event&#44; she decided to discontinue her medication&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">On March 16&#44; 2020&#44; due to fever and vomiting&#44; she was tested for SARS-CoV-2 and the result was positive&#59; a chest computed tomography scan revealed bilateral ground-glass opacities and an area of consolidation in the right lower lobe&#46; She had no significant biochemical changes or respiratory failure &#40;pH 7&#46;48&#44; pCO<span class="elsevierStyleInf">2</span> 33&#46;4 mmHg&#44; pO<span class="elsevierStyleInf">2</span> 75&#46;4 mmHg in ambient air&#41;&#46; Given the absence of criteria for hospital admission&#44; the patient was discharged for home isolation&#44; with telephone follow-up&#46; Clinical improvement and sustained apyrexia were reported&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">On March 27&#44; 2020&#44; she presented clinical worsening with oppressive chest pain radiating to the back and a prehospital emergency team was activated&#46; An electrocardiogram was performed that revealed ST-segment elevation&#46; Immediately&#44; loading doses of aspirin plus clopidogrel were administered and she was transferred to the emergency department&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">At the hospital&#44; the patient was admitted to the isolation area for COVID-19 patients in the emergency ward&#46; She was hemodynamically stable&#44; apyretic&#44; eupneic in ambient air&#44; with a peripheral oxygen saturation of 97&#37;&#46; Despite intravenous nitrate and morphine&#44; her chest pain persisted&#46; Cardiopulmonary auscultation was not performed due to interposition of personal protective equipment &#40;PPE&#41;&#46; A new electrocardiogram was performed that revealed persistent ST-elevation in leads V2-V6 &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41; and a rapid echocardiogram showed preserved biventricular systolic function with mid-apical and infero-posterolateral akinesia of the left ventricular wall&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Using PPE for aerosol-generating procedures&#44; emergent angiography performed 13 hours after symptom onset showed a good result of the previous angioplasty and non-obstructive coronary artery disease &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">For etiological clarification&#44; cardiac magnetic resonance was considered&#44; however&#44; it was postponed due to concomitant infection with SARS-CoV-2&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The patient presented clinical improvement&#44; without recurrence of chest pain after coronary angiography and without hemodynamic or electrical complications&#46; Peak high-sensitivity troponin I was 23 000 ng&#47;l&#46; One week after admission&#44; she was considered cured of COVID-19&#44; after two negative tests for SARS-CoV-2&#44; and was discharged&#44; referred for cardiology follow-up&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In this report&#44; we present a case of typical presentation of ST-elevation acute coronary syndrome&#44; without epicardial obstruction&#44; in a patient with mild COVID-19&#46; This case report highlights the challenges facing cardiology in this global pandemic&#44; in which COVID-19 can mimic a classic obstructive acute coronary syndrome&#46; It also demonstrates the need to adjust inter- and in-hospital protocols associated with direct access to primary angioplasty and to ensure that the catheterization laboratory has the appropriate equipment and conditions&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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Letter to the Editor
ST-elevation acute coronary syndrome without obstructive coronary disease in a COVID-19 patient
Síndrome coronária aguda com supradesnivelamento ST sem doença coronária obstrutiva em doente COVID-19
Tânia Proença
Corresponding author
taniagproenca@gmail.com

Corresponding author.
, Mariana Paiva, Ricardo Alves Pinto, Miguel Martins Carvalho, Ricardo Lopes, Filipe Macedo
Serviço de Cardiologia, Centro Hospitalar Universitário de São João, Porto, Portugal
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myocarditis and heart failure&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">3&#44;4</span></a> Preliminary data from Italy describe clinical presentations suggestive of acute coronary syndrome&#44; with ischemic electrical and echocardiographic changes&#44; without obstructive coronary artery disease in most patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">5&#44;6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">We present the case of a 62-year-old woman with multiple cardiovascular risk factors&#44; including hypertension&#44; dyslipidemia&#44; type 2 diabetes and previous smoking&#44; previously followed for ischemic cardiomyopathy&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In 2017&#44; the patient was admitted with acute myocardial infarction of the lateral wall and underwent emergent coronary angiography that showed total occlusion on the mid left circumflex coronary artery&#46; Angioplasty was performed and a drug-eluting stent &#40;2&#46;0 mm&#215;15 mm Resolute Onyx&#41; was implanted&#46; Her clinical course was favorable&#44; with no pathological Q waves or major ST-T changes on the electrocardiogram &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#44; normal biventricular systolic function and akinesia in the left ventricular posterior wall&#46; During an irregular cardiology follow-up of one year&#44; she had no cardiovascular symptoms&#59; two years after the event&#44; she decided to discontinue her medication&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">On March 16&#44; 2020&#44; due to fever and vomiting&#44; she was tested for SARS-CoV-2 and the result was positive&#59; a chest computed tomography scan revealed bilateral ground-glass opacities and an area of consolidation in the right lower lobe&#46; She had no significant biochemical changes or respiratory failure &#40;pH 7&#46;48&#44; pCO<span class="elsevierStyleInf">2</span> 33&#46;4 mmHg&#44; pO<span class="elsevierStyleInf">2</span> 75&#46;4 mmHg in ambient air&#41;&#46; Given the absence of criteria for hospital admission&#44; the patient was discharged for home isolation&#44; with telephone follow-up&#46; Clinical improvement and sustained apyrexia were reported&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">On March 27&#44; 2020&#44; she presented clinical worsening with oppressive chest pain radiating to the back and a prehospital emergency team was activated&#46; An electrocardiogram was performed that revealed ST-segment elevation&#46; Immediately&#44; loading doses of aspirin plus clopidogrel were administered and she was transferred to the emergency department&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">At the hospital&#44; the patient was admitted to the isolation area for COVID-19 patients in the emergency ward&#46; She was hemodynamically stable&#44; apyretic&#44; eupneic in ambient air&#44; with a peripheral oxygen saturation of 97&#37;&#46; Despite intravenous nitrate and morphine&#44; her chest pain persisted&#46; Cardiopulmonary auscultation was not performed due to interposition of personal protective equipment &#40;PPE&#41;&#46; A new electrocardiogram was performed that revealed persistent ST-elevation in leads V2-V6 &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41; and a rapid echocardiogram showed preserved biventricular systolic function with mid-apical and infero-posterolateral akinesia of the left ventricular wall&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Using PPE for aerosol-generating procedures&#44; emergent angiography performed 13 hours after symptom onset showed a good result of the previous angioplasty and non-obstructive coronary artery disease &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">For etiological clarification&#44; cardiac magnetic resonance was considered&#44; however&#44; it was postponed due to concomitant infection with SARS-CoV-2&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The patient presented clinical improvement&#44; without recurrence of chest pain after coronary angiography and without hemodynamic or electrical complications&#46; Peak high-sensitivity troponin I was 23 000 ng&#47;l&#46; One week after admission&#44; she was considered cured of COVID-19&#44; after two negative tests for SARS-CoV-2&#44; and was discharged&#44; referred for cardiology follow-up&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In this report&#44; we present a case of typical presentation of ST-elevation acute coronary syndrome&#44; without epicardial obstruction&#44; in a patient with mild COVID-19&#46; This case report highlights the challenges facing cardiology in this global pandemic&#44; in which COVID-19 can mimic a classic obstructive acute coronary syndrome&#46; It also demonstrates the need to adjust inter- and in-hospital protocols associated with direct access to primary angioplasty and to ensure that the catheterization laboratory has the appropriate equipment and conditions&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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Article information
ISSN: 21742049
Original language: English
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Revista Portuguesa de Cardiologia (English edition)
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