Coronary Artery Disease management in a Young Male with Borderline Positive Stress Test and COVID-19 History

By Dr. Parin Sangoi, Interventional Cardiologist, Wockhardt Hospitals, Mumbai Central

New Delhi, August 09, 2023: A 40-year-old male patient, Ajay Sawant (Name changed) who presented with complaints of shortness of breath, particularly aggravated while climbing stairs. The patient was under the care of Dr. Parin Sangoi. The medical investigations revealed coronary artery disease involving the left anterior descending artery (LAD). Additionally, the patient had a history of COVID-19 infection in September 2020 and had received three doses of the COVID-19 vaccine.

On evaluation, the patient’s symptoms of shortness of breath were concerning, and a stress test (Treadmill Test) was performed on 25th April 2023. The stress test showed a positive result for inducible ischemia at high workload, prompting further investigation.

Following the stress test results, the patient underwent a CT coronary angio on 26th April 2023, which revealed a significant 90% stenosis in the ostioproximal part of the LAD. Based on the diagnosis of single-vessel coronary artery disease involving the LAD, the patient was admitted.

On the same day of admission, a coronary angiography was performed to visualize the extent of coronary artery disease. The angiography confirmed the presence of significant stenosis in the LAD. To address the blockage, the patient underwent percutaneous transluminal coronary angioplasty (PTCA) involving the left main (LM) to LAD and mid LAD with OCT guidance. Following the procedure, the patient was transferred to the Intensive Care Unit (ICU).

On 28th April 2023, the patient’s condition improved significantly, and he was shifted back to the wards.

The patient’s post-procedure recovery in the wards was uneventful, with no major complications reported. His shortness of breath resolved, and he showed clinical improvement. Subsequently, the patient was discharged from the hospital, presumably with appropriate post-discharge medications and lifestyle recommendations.

This case highlights the management of coronary artery disease in a relatively young male patient presenting with atypical symptoms of shortness of breath. The diagnostic workup, including stress testing and coronary angiography, helped identify the presence and severity of coronary artery disease involving the LAD. Timely intervention through PTCA significantly improved the patient’s condition, allowing for a successful recovery.

Dr. Parin Sangoi, Interventional Cardiologist, Wockhardt Hospitals, Mumbai Central, said, “As an interventional cardiologist, it was challenging yet fulfilling to manage this case of coronary artery disease in a relatively young patient. The positive stress test coupled with the significant stenosis in the left anterior descending artery posed a clinical conundrum. However, with timely and meticulous intervention through PTCA, we achieved a successful outcome, and the patient’s recovery was gratifying. The patient’s history of COVID-19 infection and vaccination added an extra layer of consideration in the treatment plan. Collaborative efforts from our team at Wockhardt Hospitals, Mumbai Central, played a pivotal role in ensuring comprehensive care for the patient. This case reinforces the significance of personalized and evidence-based approaches in tackling cardiovascular challenges and inspires us to continually strive for excellence in patient care.”

The patient’s history of COVID-19 infection and vaccination might have played a role in the overall clinical presentation and treatment course. Further studies could be warranted to explore any potential connections between COVID-19 infection, subsequent vaccination, and cardiovascular disease.

The case underscores the importance of careful evaluation and management of patients presenting with atypical symptoms like shortness of breath. A multidisciplinary approach, including stress testing, imaging modalities, and interventional procedures like PTCA, can lead to successful outcomes in the management of coronary artery disease. Understanding the potential impact of previous COVID-19 infection and vaccination on cardiovascular health could provide valuable insights for future patient care.