The
infection by the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is associated with significant cardiovascular morbidity and mortality.
Cardiac events require prompt diagnosis and management, also in the SARS-CoV-2 era. A 58-year-old male, heavy smoker and with known
SARS-CoV-2 infection, abruptly developed severe
hypotension and
asthenia. At patients' home, emergency physicians found hemodynamic compromise with diffuse ST-elevation at electrocardiography. The patient was rapidly moved to the cardiac catheterization laboratory, and any contact with other health-care workers was avoided. Coronary angiography excluded
coronary artery disease. At admission to the coronavirus disease-2019 unit, an increase in inflammatory markers and liver
enzymes with normal
troponin levels were observed. Bedside lung ultrasonography showed interstitial syndrome and bilateral
pleural effusion, whereas echocardiography showed large and diffuse
pericardial effusion with a swinging heart. The hemodynamic status improved after gentle
fluid therapy such suggesting potential concomitant
sepsis and pericardiocentesis was not performed. At this time, a computed tomography scan showed a widespread
neoplasm in the right lung involving the subclavian artery and vein and the thoracic lymph nodes. The histology confirmed the diagnosis of a locally advanced pulmonary
adenocarcinoma. One week after admission, the patient died for worsening
respiratory failure. Not delayed primary PCI remains the standard of care for patients with suspected
ST-elevation myocardial infarction (
STEMI) in the SARS-CoV-2 era. A diagnostic deepening for potential
STEMI-mimicker (known to be associated with
SARS-CoV-2 infection and to patients' comorbidities) should be considered, and a multidisciplinary approach is needed in these patients.