Unmasking the Clinical Characteristics, Outcomes and Assessing the Frequency and Consequences of Silent Myocardial Infarction in Asymptomatic COVID-19 Survivors: A Multi Centre Study

Abstract

A condition known as silent myocardial ischemia occurs when there is a decrease in myocardial blood flow without any obvious signs, such as discomfort or chest pain. The most typical clinical manifestation of coronary artery disease (CAD) is this illness. [1] Silent myocardial infarction is detected by electrocardiogram (ECG), echocardiography, and perfusion abnormalities. Even though some patients do not have a history of CAD, silent myocardial ischemia is common in those with stable CAD. Silent ischemia is a highly reliable indicator of death. Silent ischemia, or anginal chest symptoms, are absent in about 70–80% of transitory ischemic episodes [2]. When myocardial ischemia is quiet, patients do not seek medical attention in a timely manner, which increases morbidity and mortality. Patients with diabetes mellitus (DM) who are older and have a history of myocardial infarction or revascularization are at risk. The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has introduced numerous medical complexities, particularly affecting cardiovascular health [3]. Among these, silent heart attacks, or silent myocardial infarctions (SMIs), pose a significant risk yet often go undetected due to their lack of overt symptoms. This article explores the intricate relationship between silent heart attacks and COVID-19, examining the mechanisms through which the virus exacerbates cardiovascular strain, including direct myocardial infection, systemic inflammation, and increased thrombosis risk [4]. Myocarditis, arrhythmias, and myocardial infarctions (MIs) are among the cardiovascular consequences that are increasingly known to be associated with an elevated risk during and after COVID-19 infection. In addition to possible thrombotic and inflammatory pathways, direct virally-induced damage are the mechanisms causing severe consequences. According to the latter, factors that contribute to MI-induced post-COVID-19 consequences are explored, including inflammatory plaque instability and plaque rupture [5]. Our case report details the first instance in which invasive (OCT) and non-invasive (CMR) modalities are used to uncover a silent MI caused by coronary plaque rupture due to a transient reduction of LVEF during the COVID-19 convalescence phase. When COVID-19 patients worsen, it may be necessary to rule out myocardial infarction as a differential diagnosis, particularly if dyspnea continues after an acute infection [6]. The overlap of COVID-19 symptoms with those of silent heart attacks complicates detection, necessitating vigilant cardiac monitoring and the use of biomarkers and imaging. The presence of silent heart attacks in COVID-19 patients worsens their prognosis, highlighting the need for comprehensive management strategies that include regular monitoring, anticoagulation therapy, and anti-inflammatory treatments. Understanding this interplay is crucial for improving patient outcomes and guiding effective prevention and treatment measures [7].