Discussion

Dr Uriel: The predominant presenting symptoms of this patient were cardiac in nature without symptoms suggestive of infection. Thus, although the initial ECG findings of diffuse ST elevations and elevated cardiac enzymes raised the possibility of myopericarditis, the typical diagnostic algorithm for acute coronary syndrome was followed, since this remains a more common cause of this presentation. As experience with the COVID-19 pandemic grows, the treatment pathway for cardiac presentations may also evolve rapidly. One area of uncertainty is whether to proceed to coronary angiography in response to ECG changes and positive troponin, which risks exposing additional healthcare personnel to infection. 3 Likewise, the role of endomyocardial biopsy to detect myocarditis is uncertain. In this case, hemodynamic assessment played a crucial role in the detection of profound cardiogenic shock, guiding appropriate management to achieve a successful outcome. To reduce the potential contamination associated with patient transport to the catheterization suite, bedside placement of a pulmonary artery catheter and IABP may be considered when coronary angiography is not required. Other potential