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Reviews in Cardiovascular Medicine  2020, Vol. 21 Issue (2): 289-295     DOI: 10.31083/j.rcm.2020.02.92
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High thrombus burden despite thrombolytic therapy in ST-elevation myocardial infarction in a patient with COVID-19
Gayatri Setia1, Jeffrey Tyler2, Alan Kwan2, Josh Faguet1, Shilpa Sharma2, Siddharth Singh2, Babak Azarbal2, *(), Rose Tompkins2, Dinora Chinchilla3, Sara Ghandehari3
1Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
2Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
3Division of Pulmonary and Critical Care Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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Abstract:
Consideration of thrombolysis as first-line reperfusion therapy in patients with COVID-19 and STEMI is recommended by ACC/SCAI guidelines. We describe a patient with COVID-19, who presented with ST-elevation myocardial infarction and was treated with thrombolysis and anticoagulation. He was later found to have a significant persistent thrombus burden requiring thrombectomy and stent placement. Invasive hemodynamics on multiple high-dose pressers revealed a high cardiac output state with low systemic vascular resistance, consistent with distributive rather than cardiogenic shock. Our case illustrates that thrombolytic therapy alone may not be adequate in patients with STEMI and COVID-19, as well as the importance of early invasive hemodynamics in management of shock in patient with STEMI and COVID-19 infection.
Key words:  COVID-19      acute coronary syndrome      ST-elevation myocardial infarction      thrombolysis     
Submitted:  15 May 2020      Revised:  17 June 2020      Accepted:  22 June 2020      Published:  30 June 2020     
*Corresponding Author(s):  Babak Azarbal     E-mail:  Babak.Azarbal@cshs.org

Cite this article: 

Gayatri Setia, Jeffrey Tyler, Alan Kwan, Josh Faguet, Shilpa Sharma, Siddharth Singh, Babak Azarbal, Rose Tompkins, Dinora Chinchilla, Sara Ghandehari. High thrombus burden despite thrombolytic therapy in ST-elevation myocardial infarction in a patient with COVID-19. Reviews in Cardiovascular Medicine, 2020, 21(2): 289-295.

URL: 

https://rcm.imrpress.com/EN/10.31083/j.rcm.2020.02.92     OR     https://rcm.imrpress.com/EN/Y2020/V21/I2/289

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