Minoca or post-infection coronary vasculitis of SARS-CoV2?

SARS-COV2 causes a large inflammatory response. The effects on the cardiac and vascular system are still being studied. Clinical Case: A 50-year-old man came to the emergency room of our hospital for fever and asthenia. For the positivity for SARS-COV2 and radiographic finding of bilateral interstitial pneumonia, he was hospitalized at the U.O. COVID, where for hypoxemic respiratory insufficiency he was subjected to ventilotherapy with CPAP. The improvement in respiratory failure and the negativization of the nasopharyngeal swab for SARS-COV2 indicated discharge. The patient underwent a pre-discharge ECG which showed negative T waves in the inferior site and from V3-V6 not present in the previous one. Dosage of cardiac cytonecrosis indices showed troponin T HS (34, ng/l v.n. <14 ng/l) slightly increased;blood chemistry tests show CRP equal to 26 mg/dl and normal leukocyte number and formula. The 2d color Doppler echocardiogram reported: “Akinesia of the mid-apical portion of the septum, apex and lower wall, with an FE equal to 45%. Presence of a slight pericardial detachment of the lateral wall of the left ventricle.” The patient was transferred to our U.O. of Cardiology, who underwent coronary angiography showing normal coronaries. With the suspicion of SARS-COV2 myocarditis, the patient underwent cardiac MRI which confirmed the akinesias shown on the echocardiogram. Late enhancement in subendocardial disposition consistent with an acute ischemic injury in these sites was evident on T2- weighted sequences. Discussion: Normal coronary myocardial infarctions (MINOCA) are described in the literature and it is hypothesized that the inflammatory reaction and hypoxia caused by SARS-COV2 may play a central role in the pathogenesis of ischemic disorder. The district nature of the lesion compatible with a coronary atherosclerotic obstruction not detected on angiographic examination, however, needs to be clarified. The vasculitis resulting from the infection can explain the locality of the lesion on the echocardiogram and on the ECG but opens the discussion on therapeutic choices.