IJCS | Volume 33, Nº4, July and August 2020

430 of thrombus was found and a primary percutaneous intervention (PCI) with 2 drug-eluting stents (DES) was performed. There was also a severe lesion at the proximal segment of the left anterior descending artery (LAD), which was not treated in the index procedure. The treatment of the LAD, as routinely carried out in multivessel disease patients with STEMI, was successfully performed within 48 hours with one DES. Later on that day, the patient had 2 episodes of fever without any respiratory symptoms, which were initially attributed to post-infarction stress. In the next morning, due to persistence of the fever and considering the pandemic scenario, a nasopharyngeal swab was collected, which was positive for SARS-CoV-2. Computed tomography (CT) of the chest revealed infectious focus and ground-glass opacities at the right lung. The patient was transferred from the Coronary Unit to an isolated intensive care unit dedicated to COVID-19 care. At that moment, antibiotics (Azithromycin included) were started in combination with Hydroxychloroquine (HCQ), but the fever persisted until the twelfth day of hospitalization, when there was a significant worsening of the respiratory condition, with hypoxemia and need of mechanical ventilation. Laboratory tests revealed a leukocytosis of 19.390/ mm 3 , a D-dimer of 7.348 ng/dl new troponin-I elevation (1.85 ng/ml). Transthoracic echocardiography (TTE) did not reveal any worsening of left ventricular function. A new chest CT showed increased consolidation area, at this point bilaterally, with approximately 50% of the parenchyma involved (Figure 2). The patient had an unfavorable evolution, which led to renal failure and refractory hypoxemia, despite the mechanical ventilation, evolving to death 14 days after hospital admission. Case 2 A 69-year-old man with a previous history of hypertension and no coronary artery events in the past presented to the emergency room (ER) with fever, cough and fatigue in the previous week. His symptoms worsened within the next 24 hours, with onset of dyspnea and fatigue. He was lucid, with tachydyspnea and denied chest pain. Physical examination revealed blood pressure of 200 x 110 mmHg, a heart rate of 80 bpm and oxygen saturation of 78%, with no fever. Cardiac and pulmonary auscultation showed an S3 gallop and rales. Arterial gas analysis revealed a PH 7.47, oxygen partial pressure of 66%, a carbon dioxide partial pressure of 30mmHg and lactate level of 18.8 mg/dL. Since the patient had respiratory failure and a flu-like syndrome in times of COVID-19 pandemic, orotracheal intubation and invasive ventilation were needed. Low-dose vasopressor was given after a blood-pressure drop following sedation. Only after clinical stabilization had been achieved, a 12-lead ECG was performed, which showed anterior ST elevation, Figure 1 – EKG with ST elevation in II, III, aVF and ST depression in V2,V3, V4. Esteves et al. Covid-19 and STEMI Int J Cardiovasc Sci. 2020; 33(4):429-435 Case Report