Complicated myocardial infarction in a 99-year-old lady in the era of COVID-19 pandemic: from the need to rule out coronavirus infection to emergency percutaneous coronary angioplasty

On March 20, 2020, during the COVID-19 outbreak, a 99-year-old woman with hypertension and a previous history of coronary artery disease treated with coronary angioplasty and stent in the proximal left anterior descending coronary artery was admitted to the Emergency Department of the University Hospital of Modena, in Northern Italy. No impairment of renal or hepatic function was reported in medical history. The patient, who was living at home, with her son and was autonomous and independent in daily living activities, reported dyspnea, atypical chest pain and fatigue. She also reported that in the last 3 days she had fever (up to 37.5 °C degrees) and cough. Physical examination documented bi-basal crackling. A 12-lead ECG showed sinus tachycardia with 1.5 mm depression of the ST segment and negative T waves in the antero-lateral and inferior lead. The transthoracic echocardiogram showed aortic valve sclerosis, without aortic valve stenosis, left ventricular hypertrophy, with a left ventricular ejection fraction of 50% and no regional wall abnormalities. Chest X-ray documented an increase in the reticular thickening of the peri-bronchovascular interstitium in the middle and lower fields that was more accentuated in the lower para-hilar region (Fig. 1). Further investigations and differential diagnosis