ABSTRACT
Background: Coronavirus disease 2019 (COVID-19) has emerged as a pandemic and public health crisis of an unprecedent effect. Clinical studies reported an association between COVID- 19 and cardiovascular disease, whereas COVID-19 itself can induce myocardial injury, arrhythmia, acute coronary syndrome and venous thromboembolism. Case summary: A patient diagnosed via screening CTCA with nonobstructive coronary artery disease was hospitalized with NSTEMI and atrial flutter during a severe respiratory infection episode with SARS-CoV-2. After recovery from the infectious episode FFR-guided elective PCI with drug-eluting stent was performed. Conclusions: COVID-19 intercurrence in a cardiovascular patient with nonobstructive coronary artery disease triggered coronary plaque vulnerabilization with subsequent development of acute coronary syndrome. SARS-CoV-2 proved to be involved via direct viral tissue involvement and concomitant mechanisms derived from systemic illness in development of severe supraventricular arrhythmic event.