Extended Data Fig. 3

COVID-19 infection associated with type 2 myocardial infarction and atrial fibrillation. A 68-year-old woman presented with breathlessness, a five-day febrile illness and falls due to weakness but without loss of consciousness. The admission electrocardiogram (a) revealed atrial fibrillation of presumed recent onset and a rapid ventricular rate and there were clinical signs of heart failure. Following admission, a swab PCR test for SARS-CoV-2 infection was positive. Protocol-directed coronary computed tomograph (CT) angiography revealed a dominant left coronary artery. The Agatston calcium score was 156 (815 percentile for age, gender, ethnicity) and there was atherosclerosis in the left coronary artery (c). The FFRCT ratios in the mid-left anterior descending (FFRCT = 0.71) and distal circumflex (FFRCT = 0.76) coronary arteries were reduced (abnormal < 0.80) (d). Parametric mapping revealed increases in myocardial T2 (47 ms) and T1 (1269 ms) relaxation times consistent with myocardial inflammation (e, f). Late gadolinium contrast-enhanced imaging was normal. There was bi-atrial enlargement and the left and right ventricular ejection fractions were preserved (g). The adjudicated diagnosis was acute myocardial injury and type 2 myocardial infarction in association with pre-existing coronary artery disease and acute COVID-19.