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Simultaneous Acute Portal Vein Thrombosis and ST Elevation Myocardial Infarction in a COVID-19 Patient – Case Report

8 Pages Posted: 27 Oct 2022 Publication Status: Published

See all articles by Ensieh Nournia

Ensieh Nournia

Hamedan University of Medical Sciences - Cardiologist at Be'sat hospital

Maziar Bazrafshan

Hamadan University of Medical Sciences

Abstract

Background: Covid-19 infected patients without any risk factors and family history of a thrombotic event can be still at risks of developing thrombotic and/or other Covid-19-related complications, and therefore, there is a substantial need to study such cases.

Case presentation: In this study, we present a 60-years-old Covid-19 patient with mild symptoms who was admitted to the hospital with simultaneous arterial and venous thrombotic event, with chief complaint of chest pain and vague abdominal pain. The patient was diagnosed with Covid-19 two weeks before admission to the ICU. A 12-lead electrocardiogram revealed pathologic Q-wave ST-segment elevation and T-wave inversion in II, III, aVF, and T inversion in V5 and V6. Quantitative troponin was elevated which confirmed inferior ST-elevation MI. Abdominal color Doppler sonography and CT scan with contrast demonstrated an absent flow in the portal vein and thrombosis. A chest CT scan illustrated a normal pattern. We started IV unfractionated heparin (UFH), dual antiplatelet, beta-blocker, statin, intravenous nitrate, and angiotensin-converting enzyme inhibitor. Coronary angiography showed the right coronary artery was totally cut off at the proximal part.

Here we report three main un-common characteristics associated with our patient compared to other similar studies. First, the thrombotic event in our case occurred without pulmonary involvement and the patient only had a flu-like symptom two weeks before admission. The second main difference is that the patient's arterial and venous thrombotic events had simultaneously happened, which is not common in most cases. Patient presented simultaneous portal vein thrombosis and recent ST-segment elevation Myocardial Infarction (MI). Finally, both MI and portal vein thrombosis symptoms were subtle and confusing, which could cause misdiagnosis. A post two-weeks color Doppler sonography follow-up showed portal vein thrombosis recanalization and myocardial perfusion scan had no viability and reversible ischemia in RCA territory.

Conclusions: This report addresses that a cautious diagnosis of Covid-19 at the time of admission can play a vital role in preventing cardiovascular events; where even asymptomatic to mildly infected patients could be still at higher risks of developing clinical complications (e.g., thrombotic events)

Funding Information: Not applicable.

Declaration of Interests: Not applicable.

Ethics Approval/Consent Statement: This study has been performed under the ethical principles and the national standards for conducting Medical Research in Iran. The study holds ethics approval from the Research Ethics Committee of Hamedan University of Medical Sciences (IR.UMSHA.REC1401.168). The patient was provided informed consent for their participation.

Keywords: Covid-19, acute portal vein thrombosis, ST elevation myocardial infarction, Non- Vitamin K Antagonist Oral Anticoagulants (NOAC), case report

Suggested Citation

Nournia, Ensieh and Bazrafshan, Maziar, Simultaneous Acute Portal Vein Thrombosis and ST Elevation Myocardial Infarction in a COVID-19 Patient – Case Report. Available at SSRN: https://ssrn.com/abstract=4236047 or http://dx.doi.org/10.2139/ssrn.4236047

Ensieh Nournia (Contact Author)

Hamedan University of Medical Sciences - Cardiologist at Be'sat hospital ( email )

Maziar Bazrafshan

Hamadan University of Medical Sciences ( email )

Daneshgah-e-Bu Ali Sina
Hamedan, 6517759194
Iran

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