Elsevier

The American Journal of Emergency Medicine

Volume 52, February 2022, Pages 271.e1-271.e3
The American Journal of Emergency Medicine

ST-elevation in an adolescent with COVID-19: Myopericarditis or myocardial infarction?

https://doi.org/10.1016/j.ajem.2021.08.068Get rights and content

Abstract

Myocardial infarctions (MI) have been reported in adults with COVID-19. Although MIs are rare in children with COVID-19, cardiac involvement is still possible. In this case report, we present an adolescent with recent COVID-19 infection who presented with an ECG initially suggestive of myocardial infarction (MI). We describe how to differentiate between myocardial infarctions and myopericarditis. A 15-year-old boy, with a history of COVID-19 infection a month prior, presented to the emergency department with fever, abdominal pain, diarrhea, and chest pain. On ECG, he was found to have focal ST-segment elevations in V3 through V6. Given the immediate concern for MI, an emergent echocardiogram was done and showed normal left ventricular systolic function with no regional dyskinesia and normal coronary artery diameters. A repeat ECG showed diffuse ST elevations in the inferior leads and T-wave inversions on V5 and V6, confirming the diagnosis of myopericarditis. In conclusion, multisystem-inflammatory syndrome in children associated with COVID-19 (MIS-C) is a new entity describing a post-infectious inflammatory response in children with prior COVID-19 exposure. Cardiac involvement can include myopericarditis. Initial ECGs may show ST-changes suggestive of MI. However, serial ECGs and echocardiograms can differentiate between MI and myocarditis/myopericarditis. Even with COVID-19, MIs are extremely rare in children, and it is important to be aware of MIS-C and its cardiac complications.

Keywords

COVID-19
Multisystem inflammatory syndrome in children
MIS-C
Pericarditis
Myocarditis
Myopericarditis
Myocardial infarction

Abbreviations

CRP
C-reactive protein
ESR
erythrocyte sedimentation rate
MI
myocardial infarction
MIS-C
Multisystem inflammatory syndrome in children associated with COVID-19
NT-pro-BNP
N-terminal pro-brain natriuretic peptide
STEMI
ST-elevation myocardial infarction

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