Posterior Myocardial Infarction in a 45-Year-Old Javanese Woman with a 1-Month History of COVID-19-Related Guillain-Barré Syndrome: A Challenging Emergency Diagnosis

Patient: Female, 45-year-old Final Diagnosis: Isolated posterior ST-segment elevation myocardial infarction (STEMI) Symptoms: Atypical chest pain • a burning sensation in the left chest • radiating to both arms • back and legs Medication: — Clinical Procedure: Primary percutaneous coronary intervention (PCI) Specialty: Cardiology OBJECTIVE: Challenging differential diagnosis BACKGROUND: Guillain-Barré syndrome (GBS) is an autoimmune demyelinating disease that affects peripheral nerves and may be associated with nerve pain in the upper limbs and chest. Autonomic dysfunction in GBS can result in electrocardiography (ECG) changes that include T wave inversion, ST segment depression, or ST segment elevation. Recently, GBS was been recognized as a neurological consequence of COVID-19. This report describes the challenge of emergency diagnosis of posterior myocardial infarction (MI) in a 45-year-old Javanese woman who was known to have a 1-month history of COVID-19-related Guillain-Barré syndrome. CASE REPORT: We report the case of a 45-year-old patient who presented to the Emergency Department (ED) with atypical an-gina. She had a history of GBS that started 2 weeks after she developed COVID-19. Since then, she frequently had pain in both legs and occasionally in the chest. Her electrocardiogram revealed subtle ST segment depression in the anteroseptal leads (V1–V4), along with ST segment elevation in the posterior leads (V7–V9). Cardiac marker (troponin I) was elevated and posterior regional wall motion abnormality was present on an echocardiogram. Coronary angiography revealed total occlusion of the first diagonal branch of the LAD, followed by deployment of drug-eluting stents to achieve good angiographic results. The patient was diagnosed with GBS and isolated posterior ST segment elevation myocardial infarction. CONCLUSIONS: This report shows the importance of performing standard cardiac investigations for myocardial ischemia or infarction in patients known to have Guillain-Barré syndrome so that the patient can be treated appropriately and urgently to ensure the best possible outcome.