Apparently normal epicardial coronaries in a patient with inferior wall myocardial infraction on the background of mild coronavirus disease-2019: take a second look!


  • Barun Kumar Department of Cardiology, All India Institute of Medical Sciences (AIIMS), Rishikesh, India.
  • Ashwin Kodliwadmath | Department of Cardiology, All India Institute of Medical Sciences (AIIMS), Rishikesh, India.
  • Amar Upadhyay Department of Pediatrics, Doon Medical College, Dehradun, India.
  • Anupam Singh Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Rishikesh, India.
  • Nanda N Department of Endocrinology, All India Institute of Medical Sciences (AIIMS), Rishikesh, India.


The coronary angiographic (CAG) findings of ST elevation myocardial infarction (STEMI) in patients of coronavirus disease 2019 (COVID-19) range from increased coronary artery thrombus burden to normal coronaries due to STEMI mimics. Here we report the case of a 45-year-old gentleman who presented with evolved inferior wall myocardial infarction with ongoing angina along with mild COVID-19. CAG showed normal epicardial coronaries except for distal right posterior descending coronary artery (RPDA) 100% occlusion on careful examination. He was treated for the myocardial infarction with medical management along with treatment of COVID-19. The importance of our case is to highlight the possibility of distal total occlusion of small coronary branches which may be missed if not carefully looked for as a normal CAG in COVID-19 patient will require only supportive therapy, while the finding of distal 100% occlusion of RPDA deemed us to prescribe optimal medical therapy as per acute myocardial infarction protocol along with treatment for COVID-19.



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Cardiology - Case Reports
COVID-19, ST elevation myocardial infarction, coronary angiography, thrombosis
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How to Cite
Kumar, Barun, Ashwin Kodliwadmath, Amar Upadhyay, Anupam Singh, and Nanda N. 2021. “Apparently Normal Epicardial Coronaries in a Patient With Inferior Wall Myocardial Infraction on the Background of Mild Coronavirus Disease-2019: Take a Second Look!”. Monaldi Archives for Chest Disease, April.