IJCS | Volume 33, Nº4, July and August 2020

431 Q-wave in anteroseptal leads, suggestive of a subacute transmural myocardial infarction. The chest x-ray revealed no cardiac enlargement with interstitial and alveolar edema. TTE showed normal left ventricular dimensions despite apical akinesis, with an estimatedLV ejection fraction of 44%. There was no evidence of heart valve disease. In face of all these findings suggestive of an AMI combined with a flu-like syndrome, the patient was referred to CCL. The angiography revealed a thrombotic occlusion of the mid portion of the LAD artery. The patient underwent a 2 drug-eluting stent PCI in the LAD artery, with no-reflow phenomena, and was successfully treated with intracoronary adenosine. Door-to-reperfusion time was prolonged (162 min). After coronary treatment, the patient was sent to ICU hemodynamically stable, with an oxygen saturation of 99% and a FiO2 of 80%. His laboratory tests showed elevated troponin, lymphopenia and a normal renal function. A nasopharyngeal swab (PCR) test confirmed SARS-Cov-2 infection and a chest CT showed findings of pulmonary edema, pleural effusion and intersticial ground-glass infiltrate pattern (Figure 3). He had good clinical improvement, with discharge 16 days after admission. Case 3 We present the case of a 42-year-old female without any comorbidities and onset of flu-like symptoms in the previous 7 days. She was admitted to the ER with weakness, cough and shortness of breath. She rapidly evolved with respiratory insufficiency and was submitted to orotracheal intubation and mechanical ventilation. Her initial D-dimer was 1706ng/ml and she had patterns of viral pneumonia on chest CT. Treatment with Hydroxychloroquine and Azithromycin was initiated; a nasopharyngeal swab was collected, which was positive for SARS- CoV-2. On the fourth day, the patient presented with hemodynamic instability, D-dimer elevated to 83.390 ng/ml and a troponin I level of 34.42 ng/dl. TTE revealed anterior wall hypokinesia and ECG showed anterior ST elevation. She was referred to CCL. Angiography did not reveal obstructive coronary artery disease and injection into the left ventricle showed a pattern of Takotsubo cardiomyopathy (Figure 4). Despite drug optimization and use of mechanical support, the patient had refractory shock and died within the next hours. Figure 2 – Chest Computed Tomography with bilateral involvement. Esteves et al. Covid-19 and STEMI Int J Cardiovasc Sci. 2020; 33(4):429-435 Case Report