A case of Takotsubo cardiomyopathy with COVID 19.
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ABSTRACT:
SUBMITTER: Nguyen D
PROVIDER: S-EPMC7239208 | biostudies-literature | 2020 Sep
REPOSITORIES: biostudies-literature
Publications
A case of Takotsubo cardiomyopathy with COVID 19.
Nguyen Damien D Nguyen Thomas T De Bels David D Castro Rodriguez José J
European heart journal. Cardiovascular Imaging 20200901 9
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Project description:BackgroundTakotsubo cardiomyopathy is characterized by transient regional ventricular abnormalities in the absence of coronary artery disease and is reported as a complication of COVID-19.Case presentationIt can have a diverse clinical presentation, occasionally resembling an acute coronary syndrome, and progress to acute heart failure and cardiogenic shock, adversely affecting patients' prognosis. A high index of suspicion and a thorough diagnostic approach supported by ancillary studies like echocardiography and coronary angiography is key for an accurate diagnosis and correct medical treatment. Herein, we report a patient with severe COVID-19 who developed Takotsubo cardiomyopathy.ConclusionWe also present a detailed literature review regarding the relationship between COVID-19 and Takotsubo cardiomyopathy.
| S-EPMC10201897 | biostudies-literature
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| S-EPMC7398589 | biostudies-literature
Project description:BackgroundCardiovascular complications are increasingly recognized during the current coronavirus disease 2019 (COVID-19) pandemic. Myocardial injury is most commonly described and its underlying mechanism is believed to be multifactorial. Next to Type 2 ischaemia, COVID-19 may lead to (peri)myocarditis or Takotsubo (or stress) cardiomyopathy.Case summaryA 72-year-old woman was admitted to the intensive care unit for mechanical ventilation because of respiratory insufficiency secondary to COVID-19 viral pneumonia. Seven days after admission, she developed new negative T-waves and a prolonged QTc interval on electrocardiography (ECG). Troponin levels were mildly elevated. Echocardiography showed a poor left ventricular systolic function with apical ballooning consistent with the diagnosis Takotsubo cardiomyopathy. Seven days afterwards, the ECG and troponin levels normalized. Echocardiography showed improvement of left ventricular systolic function, however with persistent hypokinesia of the apical segments. Coronary artery disease was excluded using coronary computed tomography angiography. The patient was discharged home and follow-up echocardiography after 3 months showed normal contractility of the apical myocardial segments, with normalization of the left ventricular systolic function, as expected in Takotsubo cardiomyopathy.DiscussionCOVID-19 caregivers should be aware of Takotsubo cardiomyopathy as complication of COVID-19, since regular use of QT-prolonging drugs combined with prolongation of the QTc interval in Takotsubo cardiomyopathy may lead to life-threatening arrhythmias. Furthermore, Takotsubo cardiomyopathy may lead to acute heart failure and even cardiogenic shock. Frequent ECG monitoring of COVID-19 patients therefore is of paramount importance and timely echocardiography should be obtained when ECG abnormalities or haemodynamical problems occur.
| S-EPMC7528942 | biostudies-literature
Project description:BackgroundCoronavirus disease 2019 (COVID-19) has a great impact on both, physical and psychological wellbeing. The COVID-19 pandemic promoted increasing digitalization of the work environment and social isolation. This psychosocial stress in turn can induce physical distress with clinical manifestation. So can the changed work and social environment in the COVID-19 pandemic trigger acute cardiovascular disease?Case descriptionHere, we present a case of a 56-year-old postmenopausal woman suffering from Takotsubo cardiomyopathy (TTC) evoked by emotional stress during a virtual work meeting. Like many others, our patient was urged to work from home (WFH) in accordance with the contact restrictions due to COVID-19. She presented at our chest pain unit with typical angina pectoris-like symptoms such as chest pain and dyspnea. Laboratory analysis confirmed increased troponin levels and evolving T wave inversion in electrocardiogram. Acute coronary syndrome management was commenced. Coronary angiography and left ventriculography revealed non-obstructive coronary arteries and apical ballooning syndrome. Due to immediate guideline-directed treatment with bisoprolol, ramipril, spironolactone and acetylsalicylic acid the patient's condition improved so that she could be discharged after seven days. During a 3-month follow-up the patient showed a normalized ejection fraction and reported no discomfort anymore.ConclusionsThe ongoing COVID-19 pandemic has also elucidated the importance of the psychosocial health issues in acute cardiovascular care. Having in mind that the social and work environment recently has changed immensely, thus enforcing social isolation and emotional distress, doctors as well as patients must consider TTC as possible etiology of sudden chest pain.
| S-EPMC10628416 | biostudies-literature
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| S-EPMC7424304 | biostudies-literature
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| S-EPMC7348613 | biostudies-literature
Project description:BackgroundCardiovascular complications of severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV2) are known to be associated with poor outcome. A small number of case series and reports have described cases of myocarditis and ischaemic events, however, knowledge on the aetiology of acute cardiac failure in SARS-CoV2 remains limited. We describe the occurrence and risk stratification imaging correlates of 'takotsubo' stress cardiomyopathy presenting in a patient with Coronavirus Disease 2019 (COVID-19) in the intensive care unit. An intubated 53-year old patient with COVID19 suffered acute haemodynamic collapse in the intensive care unit, and was thus investigated with transthoracic echocardiography (TTE), 12-lead electrocardiograms (ECG) and serial troponins and blood tests, and eventually coronary angiography due to clinical suspicion of ischaemic aetiology. Echocardiography revealed a reduced ejection fraction, with evident extensive apical akinesia spanning multiple coronary territories. Troponins and NT-proBNP were elevated, and ECG revealed ST elevation: coronary angiography was thus performed. This revealed no significant coronary stenosis. Repeat echocardiography performed within the following week revealed a substantial recovery of ejection fraction and wall motion abnormalities. Despite requirement of a prolonged ICU stay, the patient now remains clinically stable, and is on spontaneous breathing.ConclusionThis case report presents a case of takotsubo stress cardiomyopathy occurring in a critically unwell patient with COVID19 in the intensive care setting. Stress cardiomyopathy may be an acute cardiovascular complication of COVID-19 infection. In the COVID19 critical care setting, urgent bedside echocardiography is an important tool for initial clinical assessment of patients suffering haemodynamic compromise.
| S-EPMC8383239 | biostudies-literature
Project description:BACKGROUND: Takotsubo cardiomyopathy is a novel, yet well-described, reversible cardiomyopathy triggered by profound psychological or physical stress with a female predominance. OBJECTIVE: This review is designed to increase general clinician awareness about the diagnosis, incidence, pathogenesis, and therapies of this entity. DATA SOURCES: A complete search of multiple electronic databases (Pubmed, EMBASE, Science Citation Index) was carried out to identify all full-text, English-language articles published from 1980 to the present date and relevant to this review. REVIEW METHODS: The following search terms were used: takotsubo cardiomyopathy, stress-induced cardiomyopathy, and left ventricular apical ballooning syndrome. Citation lists from identified articles were subsequently reviewed and pertinent articles were further identified. RESULTS: Takotsubo cardiomyopathy is typically characterized by the following: 1) acute onset of ischemic-like chest pain or dyspnea, 2) transient apical and mid-ventricular regional wall-motion abnormality, 3) minor elevation of cardiac biomarkers, 4) dynamic electrocardiographic changes, and 5) the absence of epicardial coronary artery disease. The pathogenesis of the syndrome is unknown but has mostly been associated with acute emotional or physiologic stressors. Dote, Sato, Tateishi, Uchida, Ishihara (J Cardiol. 21(2):203-214, 1991); Desmet, Adriaenssens, Dens (Heart. 89(9):1027-1031, Sep., 2003); Bybee, Kara, Prasad, et al. (Ann Intern Med. 141(11):858-865, Dec 7, 2004); Sharkey, Lesser, Zenovich, et al. (Circulation. 111(4):472-479, Feb 1, 2005) The short and long-term prognosis of these patients is overwhelmingly favorable and often only requires supportive therapy. CONCLUSION: Whether an emotional or physical event precedes one's symptoms, it is apparent that takotsubo cardiomyopathy case presentations mimic ST-segment elevation myocardial infarction, and thus is an important entity to be recognized by the medical community.
| S-EPMC2585677 | biostudies-other
Project description:BackgroundTakotsubo cardiomyopathy is a transient left ventricular dysfunction with an established recurrence rate in populations, however, recurrences in the same individual have not been well described.Case summaryWe present a 76-year-old woman who had likely a total of six recurrent takotsubo cardiomyopathy episodes spanning over 33 years. Her diagnosis of takotsubo cardiomyopathy was first made in 2014 when she presented with chest pain, raised cardiac enzymes, and the presence of normal coronary arteries. Cardiac magnetic resonance was performed, ruling out any current or previous myocardial infarction. Subsequently, she had two further recurrences in 2015 and 2018. Stressors were identified on three occasions. She was diagnosed with 'myocardial infarction' in 1986, 1988, and 1998 when she presented with chest pain and electrocardiogram changes, despite demonstrating normal coronary arteries on each occasion.DiscussionThis case demonstrates three confirmed recurrent episodes of takotsubo in the same individual, showing three different left ventricular phenotypic morphologies on the background of three previous episodes of 'myocardial infarction with normal coronary arteries', which most likely might have been takotsubo episodes as well. Any myocardial infarction-type injury was definitely ruled out in the 2014 admission instigating a potential change in this patient's past medical history and implicitly requirement for lifelong secondary prevention. It is notably difficult to make a confirmed diagnosis of takotsubo cardiomyopathy back in 1986, 1988, and 1998 due to the lack of awareness in this novel topic.
| S-EPMC7042134 | biostudies-literature
Project description:BackgroundCOVID-19 has recently been associated with the development of Takotsubo cardiomyopathy (TCM). This scoping review aims to summarize the existing evidence regarding TCM in COVID-19 and offer future direction for study.MethodsFollowing the PRISMA Extension for Scoping Reviews, MEDLINE and EMBASE were searched for all peer-reviewed articles with relevant keywords including "Takotsubo", "Stress-induced cardiomyopathy" and "COVID-19" from their inception to September 25, 2021.ResultsA total of 40 articles with 52 cases were included. Patients with TCM and COVID-19 showed only slight female predominance (59.6%), median age of 68.5 years, and were mostly of the apical subtype (88.6%). All-cause mortality was 36.5%. The median LVEF was 30%. Compared to those without TCM, those with TCM in COVID-19 had more critical illness, higher mortality, lower LVEF, and higher cardiac and inflammatory biomarkers. Notably, the diagnostic criteria of TCM were considerably different between case reports and observational studies.ConclusionThis scoping review identifies that TCM in COVID-19 may have distinct features that distinguish this condition from TCM without COVID-19. Future studies are warranted to help describe risk factors, determine the utility of inflammatory biomarkers and serum catecholamine levels, and establish disease-specific diagnostic criteria.
| S-EPMC8802667 | biostudies-literature