We report the case of a 52-year-old white male who was recently diagnosed with symptomatic COVID-19 and presented to the hospital with incessant VT/VF cardiac arrest, ST elevation myocardial infarction (STEMI) and profound hypokalemia. The patient was successfully treated with primary percutaneous coronary intervention (PCI) and concurrent aggressive potassium repletion. To the authors’ knowledge, this is the first case of COVID-19 presenting not only with an acute coronary thrombosis but also severe hypokalemia, both of which contributed to his cardiac arrest. The association of COVID-19 with acute coronary thromboses, including the challenges surrounding the diagnosis and management in this patient population is discussed. Additionally, the effect of COVID-19 on the renin-angiotensin-aldosterone-system (RAAS) is reviewed with a focus on hypokalemic presentations
