BACKGROUND 

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19) has reached pandemic levels by March 2020. Patients with cardiovascular disease, particularly with cardiac injury represent a vulnerable population and increased risk of mortality and morbidity. There is still no guidelines for management of cardiovascular disease during the COVID-19 pandemic.

CASE ILLUSTRATION 

An unconscious 52-year-old male brought to ER with complaints of abdominal discomfort and nausea. The patient had a cardiac arrest in ER and ROSC was obtained. The patient was intubated ECG showed anterior STEMI and primary PCI was performed. The endotracheal tube was changed due to blockage of excessive and thick slime. Tracheostomy was performed.   Bronchoscopy was performed and found tracheal mucosal edema, 

hyperemic and easily bleed; mucous plug and blood clots in the tip of tracheostomy cannula. 

Thoracic CT-Scan showed ground-glass appearance and fibrosis of the 6th thoracic dextra segment. PCR SARS-CoV-2 showed reactive. The patient was discharged from our hospital after three weeks with clinically stable and referred to COVID-19 center hospital nearby his home for another two weeks. After PCR SARS CoV-2 was performed twice showed negative results, the patient was discharged.

CONCLUSION 

SARS-CoV-2 infection may lead to acute myocardial injury through viral systemic inflammation, although specific mechanism remained uncertain. A thick mucus plaque and stool cell may be a specific clinical features in COVID-19 patients. Tracheostomy has a continuing role in managing weaning from extended periods of mechanical ventilation during the COVID-19 pandemic

Dr. Herawati Isnanijah completed her fellowship in the field of cardiac intervention as well as intensive and cardiovascular care at the age of 44 years from Faculty of Medicine University of Indonesia, Indonesia. She is the head of the intensive cardiovascular care unit in Pasar Rebo Hospital. She has been serving as the head of the hospital quality committee at Citra Sari Husada Hospital for the past 2 years and is a member of The Indonesian Society of Interventional Cardiology as well as The Indonesia Intensive and Acute Cardiovascular Care since 2015.