IJCS | Volume 33, Nº4, July and August 2020

DOI: https://doi.org/10.36660/ijcs.20200122 Introduction The current global pandemic caused by the new coronavirus (COVID-19) already reaches 185 countries with approximately 3 million infected people and more than 200 thousand deaths. 1,2 With continental dimensions and an elevated socioeconomic disparity, Brazil, by the beginning ofMay, presentswith increasing infection rates and mortality close to 8%. The numbers may be higher considering the lack of adequate testing of the population and healthcare professionals. 3 According to the World Health Organization (WHO), cardiovascular diseases represent the leading cause of deaths around the world. 1 . Recent reports confirmed that patients with cardiovascular comorbidities are at a higher risk to develop the most severe form of the COVID-19. 4-6 The association between these two pathologies can lead to high morbidity and mortality rates and has been the object of continuous efforts by the medical community. In this sense the management of Acute Coronary Syndrome (ACS) has undergone changes in both diagnosis and treatment since the beginning of the pandemic. 7-10 Another aggravating factor regarding the approach of ACS during this period is the multiple clinical presentations and differential diagnosis associated with COVID-19, such as myopericarditis, pulmonary embolism and arrhythmia. 4-6 We report a series of three cases of ST-elevation myocardial infarction (STEMI) that represent the impact of COVID-19 in the management of ACS and the main protocol adaptations in the largest private hospital group in Brazil (Rede D’OR São Luiz). This report was approved by the responsible Ethics Committee and the Informed Consent Form was not required. Case 1 We report the case of a 71-year-old male with systemic arterial hypertension (in use of angiotensin II receptor blocker), insulin dependent diabetes mellitus and dyslipidemia referred to the cardiovascular emergency unit due to oppressive chest pain initiated in the previous 24 hours, which worsened within the next 2 hours. He denied flu-like symptoms and reported fear of going to a hospital due to the risk of contamination by SARS-CoV-2. At admission, vital signs were stable and physical examination revealed no significant changes. The electrocardiogram (ECG) showed ST-Elevation at inferior leads and ST depression in V2-V4 (Figure 1). According to the institutional protocol, the patient was treated with Aspirin 300 mg, Ticagrelor 180 mg, Atorvastatin 80 mg and was immediately sent to the Cardiac Catheterization Laboratory (CCL). A total obstruction in the proximal segment of the right coronary artery (RCA) associated with a large amount 429 CASE REPORT International Journal of Cardiovascular Sciences. 2020; 33(4):429-435 Mailing Address: Vinicius Esteves Rua Engenheiro Oscar Americano, 840. Postal Code: 05673-050, São Paulo, SP - Brazil E-mail: vinasp@hotmail.com, vinasp@icloud.com The Association between Covid-19 and ST Elevation Myocardial Infarction: Variable Clinical Presentations on a Case Report Series Vinicius Esteves, 1 C leverson Neves Zukowski, 2 F abio Augusto de Luca, 1 I talo Bruno dos Santos Sousa, 1 B runo Santana Bandeira, 2 A ngelina Camiletti, 2 Guilherme Arruda, 1 A ndré Feldman, 1 O lga Ferreira de Souza 1, 2 Rede D'Or São Luiz, São Paulo, 1 SP - Brazil Rede D’Or São Luiz, Rio de Janeiro, 2 RJ - Brazil Manuscript received May 15, 2020; revised manuscript May 23, 2020; accepted June 07, 2020. Coronavirus; COVID-19; Pandemics; ST Elevation Myocardial Infarction; Morbidity and Mortality; Acute Coronary Syndrome; Diabetes Mellitus; Hypertension; Chest Pain; Severe Acute Respiratory Syndrome. Keywords