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Baatyr A. Zhakypov, Zairbek A. Syrgaev, Abai K. Turdubaev

Scientific Research Institute of Heart Surgery and Organ Transplantation, Bishkek, Kyrgyzstan

COVID-19 pandemic is currently the most urgent health problem. However, at the time when all the emphasis shifted to the coronavirus many patients with other diseases experienced serious difficulties in getting help, especially patients with heart disease. We present here the case of acute coronary syndrome with total occlusion of right coronary artery successfully treated with PCI and stenting during COVID-19 pandemics.

A 58-year-old woman woke up at about 2 am due to discomfort in the left chest area. At first, she did not understand the meaning and thought it would pass. However, by 6 am the pain began to intensify having burning and pressing character. She was  admitted to the intensive care unit by ambulance service. On electrocardiogram (ECG) she had ST-elevation in inferior leads – II, III, AVF (Fig. 1 top), but her troponin level was normal. 

After receiving informed consent from patient and her relatives, we decided to perform coronary angiography and PCI with stenting. On coronary angiography, a total occlusion of right coronary artery (RCA) was revealed (Fig. 2, Video 1). Video 2 and Figure 3 demonstrate stenosis of RCA where thrombus was formed. After deployment of stent, the full patency of RCA was restored (Video 3, Figure 4). The ECG (Fig. 1 bottom) showed resolution of ST segment elevation. The patient is in excellent condition and feels well.

Patients should seek medical care promptly in case of chest pain and heart disease despite pandemics and timely applied treatment by heart team is life-saving.

Figure 1. Top) ST-segment elevation in leads II, III and aVF, q wave II, III, aVF and ST depression in lead I, aVL; Bottom)  ST segment resolution in leads II, III, aVF, q wave and negative T wave II, III, aVF ,

 

Figure 2.  Total occlusion of right coronary artery (red arrow)