Takotsubo Syndrome in Coronavirus Disease 2019

Around one-fifth of patients with coronavirus disease 2019 (COVID-19) show evidence acute myocardial injury. The precise etiology remains unclear and the observation that some do not obstructive coronary artery on angiography has further complicated our understanding pathophysiology. Takotsubo syndrome (TTS) constitutes an heart failure may represent a form catecholaminergic stunning. TTS presents typical symptoms syndrome, like observed in COVID-19. Eleven COVID-19 who were diagnosed based current criteria included compared to 97 alone 3,215 elucidate features develop infer underlying pathology. Furthermore, we have stratified injury into 2 groups: those wall motion abnormalities without. While disproportionately affected men (68.0%), most COVID-19+TTS women (81.8%). Most had either physical (72.7%) or emotional (18.2%) triggers, likely from infection severe respiratory 2. Patients also tended be older (mean age 72.4 years) 58.5 67.8 years). Chest pain was more common among TTS, irrespective COVID-19, whereas dyspnea prevalent TTS. Importantly, developed significantly worse outcomes terms rates therapy in-hospital death (70.0%) than traditional cases (18.6%) (Figure 1) . Troponin brain natriuretic peptide (BNP) levels typically elevated at time admission injury, suggesting systemic inflammatory response precipitating troponin release these patients. In contrast, BNP generally low upon but increased during hospitalization. Left ventricular ejection fraction reduced all groups analyzed. Some COVID-19-associated global impairment, which postulate actually Although regional (e.g., apical ballooning), “globally” been observed.1Bybee Kevin A Prasad Stress-related cardiomyopathy syndromes.Circulation. 2008; 118: 397-409Crossref PubMed Scopus (441) Google Scholar It is conceivable cytokine storm catecholamine surge cause “global” basal myocardium able compensate, leading hypokinesia 1). localized edema region abnormality cardiac magnetic resonance (CMR) images. Meanwhile, marked biventricular pattern reported case injury.2Inciardi RM Lupi L Zaccone G Italia Raffo M Tomasoni D Cani DS Cerini Farina Gavazzi E Maroldi R Adamo Ammirati Sinagra Lombardi CM Metra Cardiac involvement patient (COVID-19).JAMA Cardiol. 2020; 5: 819-824Crossref (1190) We showed CMR addition Indeed, as both can trigger microcirculatory dysfunction,3Madjid Safavi-Naeini P Solomon SD Vardeny O Potential effects coronaviruses cardiovascular system: review.JAMA 831-840Crossref (1177) it possible they could act jointly resulting significant complications. particular, occurs work concert exaggerated sympathetic stimulation activate similar (albeit currently unknown) pathways, dysfunction, global/regional edema, decompensated failure. Of note, contraction band necrosis mononuclear infiltration four six died due underwent autopsy comparison coagulation ischemia, seen result biopsy procedure reflects toxicity hyperactivity.4Cebelin MS Hirsch CS Human stress cardiomyopathy. Myocardial lesions victims homicidal assaults without internal injuries.Hum Pathol. 1980; 11: 123-132Crossref (206) presence previously TTS,5Nef HM Mollmann H Kostin S Troidl C Voss Weber Dill T Rolf Brandt Hamm CW Elsasser Tako-Tsubo cardiomyopathy: intraindividual structural analysis phase after functional recovery.Eur Heart J. 2007; 28: 2456-2464Crossref (329) potentially reflecting overdrive. Contraction bands combination infiltration, argue against artifactual changes indicative left dysfunction. Therefore, earlier reveal true incidence impaired normal arteries. summary, hypothesize disturbances sudden calcium influx, culminating necrosis. dual diagnosis COVID are risk adverse events. authors no conflict interest disclose.