Triple Whammy: Concurrent High-Altitude Exposure and COVID-19 Infection Presenting With STEMI

Background: High altitude is associated with altered cardiovascular, pulmonary, and blood physiology which can lead to various cardiovascular complications. The world is now facing grave pandemic of COVID-19, which has affected all regions of the world including high-altitude regions. Management of COVID-19 infection along with a medical emergency like acute coronary syndrome at high altitude is extremely challenging.Case Presentation: We present a 57-year-old paramilitary officer, acclimatized to high altitude who developed sore throat, fever, and cough while he was posted at an altitude of 3,500 m. Evaluation revealed positive reverse transcriptase polymerase chain reaction (RT-PCR) test for COVID-19; hence, he was managed in isolation ward with symptomatic therapy. During the hospital stay, he developed anterior wall ST-elevation myocardial infarction (STEMI) for which he underwent thrombolysis with Tenecteplase. He underwent air evacuation to a tertiary care center located at an altitude of 320 m. Three days later, his repeat RT-PCR was negative. However, he complained of angina at rest; hence, he underwent coronary angiography which revealed significant mid-left anterior descending artery disease for which percutaneous coronary intervention was done successfully. Patient was discharged on optimal medical management, and on follow-up at 1 month he remained asymptomatic.Conclusion: This case highlights the deleterious effects of high altitude on cardiovascular system which can get worsened by COVID-19 infection. In patients suffering triple whammy of high-altitude exposure, COVID-19 infection and STEMI, multipronged approach involving timely medical management, rapid evacuation, and necessary intervention can provide optimal clinical outcomes.