https://doi.org/10.4081/monaldi.2021.1710
A review of the presentation and outcome of Takotsubo cardiomyopathy in COVID-19
Submitted: November 30, 2020
Accepted: January 23, 2021
Published: March 23, 2021
Accepted: January 23, 2021
Abstract Views: 6942
PDF: 2170
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Although the most frequent presentation of the novel Coronavirus disease-2019 (COVID-19) is a respiratory syndrome, cardiac involvement is being increasingly recognized. One such entity is Takotsubo cardiomyopathy. We sought to review the various cases of Takotsubo cardiomyopathy reported during the COVID-19 pandemic and consolidate the information available on its clinical features, evaluation and treatment. We performed a PubMed search using the MeSH terms “Takotsubo Cardiomyopathy” or “Stress Cardiomyopathy” and “COVID-19”, and identified 16 case reports, two case series, and one retrospective cohort study. There was a total of 24 reported patients with COVID-19 infection, who developed takotsubo cardiomyopathy, and two patients without COVID-19 who developed takotsubo cardiomyopathy due to the emotional stress associated with the global pandemic. The mean age of the patients was 67.19 years (SD 15.83) and 16(59.3%) were women. Chest pain was reported in only ten patients (38.46 %) and ST-elevation was seen in 11 patients (42.3%). While most patients had typical takotsubo cardiomyopathy, four patients had inverted(reverse) takotsubo cardiomyopathy, two had bi-ventricular involvement, one had median Takotsubo and another had global Takotsubo with apical sparing variant. Most patients had a positive outcome with complete or near-complete reversal of cardiac dysfunction at the time of discharge. Five deaths (19.23%) were reported. Takotsubo cardiomyopathy is a rare, but increasingly reported reversible cardiomyopathy that can be seen in patients with COVID-19 infection and the diagnosis must be actively sought for in these patients.
Li Q, Guan X, Wu P, et al. Early transmission dynamics in Wuhan, China, of Novel coronavirus–infected pneumonia. N Engl J Med 2020; 382:1199–207.
DOI: https://doi.org/10.1056/NEJMoa2001316
Guan W, Ni Z, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020; 382:1708-1720
DOI: https://doi.org/10.1056/NEJMoa2002032
Stokes EK, Zambrano LD, Anderson KN, et al. Coronavirus disease 2019 case surveillance — United States, January 22–May 30, 2020. Morb Mortal Wkly Rep. 2020; 69:759–65.
DOI: https://doi.org/10.15585/mmwr.mm6924e2
Akashi YJ, Goldstein DS, Barbaro G, Ueyama T. Takotsubo cardiomyopathy. Circulation. 2008; 118:2754–62.
DOI: https://doi.org/10.1161/CIRCULATIONAHA.108.767012
Prasad A, Lerman A, Rihal CS. Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): A mimic of acute myocardial infarction. Am Heart J. 2008; 155:408–17.
DOI: https://doi.org/10.1016/j.ahj.2007.11.008
Sato M, Fujita S, Saito A, et al. Increased incidence of transient left ventricular apical ballooning (so-called `Takotsubo’ cardiomyopathy) after the mid-niigata prefecture earthquake. Circ J. 2006; 70:947–53.
DOI: https://doi.org/10.1253/circj.70.947
Chadha S. “COVID-19 pandemic” anxiety-induced Takotsubo cardiomyopathy. QJM Mon J Assoc Physicians. 2020; 113:488–90.
DOI: https://doi.org/10.1093/qjmed/hcaa135
Rivers J, Ihle JF. COVID-19 social isolation-induced Takotsubo cardiomyopathy. Med J Aust. 2020; 213:336-336.e1.
DOI: https://doi.org/10.5694/mja2.50770
Nguyen D, Nguyen T, De Bels D, Castro Rodriguez J. A case of Takotsubo cardiomyopathy with COVID-19. Eur Heart J Cardiovasc Imaging. 2020 Sep 1;21(9):1052.
DOI: https://doi.org/10.1093/ehjci/jeaa152
Bhattacharyya PJ, Attri PK, Farooqui W. Takotsubo cardiomyopathy in early term pregnancy: A rare cardiac complication of SARS-CoV-2 infection. BMJ Case Rep. 2020; 13: e239104.
DOI: https://doi.org/10.1136/bcr-2020-239104
Jabri A, Kalra A, Kumar A, et al. Incidence of stress cardiomyopathy during the coronavirus disease 2019 pandemic. JAMA Netw Open. 2020; 3:e2014780.
DOI: https://doi.org/10.1001/jamanetworkopen.2020.14780
Tsao CW, Strom JB, Chang JD, Manning WJ. COVID-19-associated stress (Takotsubo) cardiomyopathy. Circ Cardiovasc Imaging. 2020; 13:e011222.
DOI: https://doi.org/10.1161/CIRCIMAGING.120.011222
Dave S, Thibodeau JT, Styrvoky K, Bhatt SH. Takotsubo cardiomyopathy in a coronavirus disease-2019–positive patient: A case report. AA Pract. 2020; 14:e01304.
DOI: https://doi.org/10.1213/XAA.0000000000001304
Solano-López J, Sánchez-Recalde A, Zamorano JL. SARS-CoV-2, a novel virus with an unusual cardiac feature: Inverted Takotsubo syndrome. Eur Heart J. 2020; 41:3106.
DOI: https://doi.org/10.1093/eurheartj/ehaa390
Faqihi F, Alharthy A, Alshaya R, et al. Reverse Takotsubo cardiomyopathy in fulminant COVID-19 associated with cytokine release syndrome and resolution following therapeutic plasma exchange: A case-report. BMC Cardiovasc Disord. 2020 26; 20:389.
Hegde S, Khan R, Zordok M, Maysky M. Characteristics and outcome of patients with COVID-19 complicated by Takotsubo cardiomyopathy: Case series with literature review. Open Heart. 2020; 7:e001360.
DOI: https://doi.org/10.1136/openhrt-2020-001360
Minhas AS, Scheel P, Garibaldi B, et al. Takotsubo syndrome in the setting of COVID-19. JACC Case Rep. 2020; 2:1321–5.
DOI: https://doi.org/10.1016/j.jaccas.2020.04.023
Sala S, Peretto G, Gramegna M, et al. Acute myocarditis presenting as a reverse Tako-Tsubo syndrome in a patient with SARS-CoV-2 respiratory infection. Eur Heart J. 2020; 41:1861–2.
DOI: https://doi.org/10.1093/eurheartj/ehaa286
Pasqualetto MC, Secco E, Nizzetto M, et al. Stress cardiomyopathy in COVID-19 disease. Eur J Case Rep Intern Med. 2020; 7: 001718.
Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA. 2020; 323:1061–9.
DOI: https://doi.org/10.1001/jama.2020.1585
Mishra AK, Lal A, Sahu KK, et al. Quantifying and reporting cardiac findings in imaging of COVID-19 patients. Monaldi Arch Chest Dis. 2020; 90.
DOI: https://doi.org/10.4081/monaldi.2020.1394
Veillet-Chowdhury M, Hassan SF, Stergiopoulos K. Takotsubo cardiomyopathy: A review. Acute Card Care. 2014; 16:15–22.
DOI: https://doi.org/10.3109/17482941.2013.869346
Hoffmann M, Kleine-Weber H, Schroeder S, et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell. 2020; 181:271-280.e8.
DOI: https://doi.org/10.1016/j.cell.2020.02.052
Siripanthong B, Nazarian S, Muser D, et al. Recognizing COVID-19–related myocarditis: The possible pathophysiology and proposed guideline for diagnosis and management. Heart Rhythm. 2020; 17:1463–71.
DOI: https://doi.org/10.1016/j.hrthm.2020.05.001
Papanikolaou J, Tsolaki V, Makris D, Zakynthinos E. Early levosimendan administration may improve outcome in patients with subarachnoid hemorrhage complicated by acute heart failure. Int J Cardiol. 2014; 176:1435–7.
DOI: https://doi.org/10.1016/j.ijcard.2014.08.039
Mrozek S, Srairi M, Marhar F, et al. Successful treatment of inverted Takotsubo cardiomyopathy after severe traumatic brain injury with milrinone after dobutamine failure. Heart Lung J Crit Care. 2016; 45:406–8.
DOI: https://doi.org/10.1016/j.hrtlng.2016.06.007
Santoro F, Ieva R, Ferraretti A, et al. Hemodynamic effects, safety, and feasibility of intravenous esmolol infusion during Takotsubo cardiomyopathy with left ventricular outflow tract obstruction: Results from a multicenter registry. Cardiovasc Ther. 2016; 34:161–6.
DOI: https://doi.org/10.1111/1755-5922.12182
Isogai T, Matsui H, Tanaka H, et al. Early β-blocker use and in-hospital mortality in patients with Takotsubo cardiomyopathy. Heart Br Card Soc. 2016; 102:1029–35.
DOI: https://doi.org/10.1136/heartjnl-2015-308712
Mishra AK, Lal A, Sahu KK, Sargent J. Cardiovascular factors predicting poor outcome in COVID-19 patients. Cardiovasc Pathol. 2020; 49:107246.
DOI: https://doi.org/10.1016/j.carpath.2020.107246
Mishra AK, Sahu KK, George AA, Lal A. A review of cardiac manifestations and predictors of outcome in patients with COVID – 19. Heart Lung. 2020; 49:848–52.
DOI: https://doi.org/10.1016/j.hrtlng.2020.04.019
Roca E, Lombardi C, Campana M, et al. Takotsubo syndrome associated with COVID-19. Eur J Case Rep Intern Med. 2020; 7(5): 001665.
DOI: https://doi.org/10.12890/2020_001665
Meyer P, Degrauwe S, Van Delden C, et al. Typical Takotsubo syndrome triggered by SARS-CoV-2 infection. Eur Heart J. 2020;41:1860.
DOI: https://doi.org/10.1093/eurheartj/ehaa306
Taza F, Zulty M, Kanwal A, Grove D. Takotsubo cardiomyopathy triggered by SARS-CoV-2 infection in a critically ill patient. BMJ Case Rep. 2020;13:e236561 .
DOI: https://doi.org/10.1136/bcr-2020-236561
Moderato L, Monello A, Lazzeroni D, et al. [Takotsubo syndrome during SARS-CoV-2 pneumonia: a possible cardiovascular complication]. G Ital Cardiol (2006). 2020; 21:417–20.
Dabbagh MF, Aurora L, D’Souza P et al. Cardiac tamponade secondary to COVID-19. JACC Case Rep. 2020; 2:1326–30.
DOI: https://doi.org/10.1016/j.jaccas.2020.04.009
Faqihi F, Alharthy A, Alshaya R, et al. Reverse takotsubo cardiomyopathy in fulminant COVID-19 associated with cytokine release syndrome and resolution following therapeutic plasma exchange: a case-report. BMC Cardiovasc Disord. 2020; 20:389.
DOI: https://doi.org/10.1186/s12872-020-01665-0
Oyarzabal L, Gómez-Hospital JA, Comin-Colet J. Tako-tsubo syndrome associated with COVID-19. Rev Espanola Cardiol Engl Ed. 2020; 73:846.
DOI: https://doi.org/10.1016/j.recesp.2020.06.022
How to Cite
John, Kevin, Amos Lal, and Ajay Mishra. 2021. “A Review of the Presentation and Outcome of Takotsubo Cardiomyopathy in COVID-19”. Monaldi Archives for Chest Disease 91 (3). https://doi.org/10.4081/monaldi.2021.1710.
Copyright (c) 2021 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Similar Articles
- Matteo Petroncini, Leonardo Valentini, Piergiorgio Solli, Pietro Bertoglio, Giant lung bulla as a late-onset complication of mild SARS-CoV-2 pneumonia , Monaldi Archives for Chest Disease: Vol. 94 No. 3 (2024)
- Antonello D’Andrea, Raffaella Scarafile, Ilaria Ferrara, Maria Luisa De Rimini, Pietro Muto, Maria Giovanna Russo, Raffaele Calabrò, An unusual case of apical hypertrophic cardiomyopathy in a transplanted heart , Monaldi Archives for Chest Disease: Vol. 74 No. 4 (2010): Cardiac series
- Grazia Mazzeo, Luigi Aronne, Domenica Francesca Mariniello, Valentino Allocca, Maria Ilaria Palma, Francesco Saverio Cerqua, Carlo Iadevaia, Adriano Costigliola, Roberto Parrella, Andrea Bianco, Vanvitelli/Monaldi COVID Group, Which impact for proton pump inhibitors in SARS-CoV-2 pneumonia , Monaldi Archives for Chest Disease: Vol. 91 No. 4 (2021)
- Astha Guliani, Abhishek Tandon, Amartya Chakroborty, Prem Parkash Gupta, Predictors of post COVID complications in patients admitted with moderate to severe COVID symptoms: A single center, prospective, observational study , Monaldi Archives for Chest Disease: Vol. 93 No. 2 (2023)
- Olga Vriz, Talal Alzahrani, Irene Landi, Ali Hassan Mushtaq, Abdullah Shaik, Ahmed Nahid Elshaer, Age-sex effect on in-hospital complications and mortality in patients with Takotsubo syndrome. Insights from the National Inpatient Sample , Monaldi Archives for Chest Disease: Vol. 94 No. 1 (2024)
- Kenan Yalta, Ertan Yetkin, Tulin Yalta, Systemic inflammation in patients with Takotsubo syndrome: a review of mechanistic and clinical implications , Monaldi Archives for Chest Disease: Vol. 91 No. 2 (2021)
- Olga Vriz, Hani AlSergani, Ahmed Nahid Elshaer, Abdullah Shaik, Ali Hassan Mushtaq, Michele Lioncino, Bandar Alamro, Emanuele Monda, Martina Caiazza, Ciro Mauro, Eduardo Bossone, Zuhair N. Al-Hassnan, Dimpna Albert-Brotons, Giuseppe Limongelli, A complex unit for a complex disease: the HCM-Family Unit , Monaldi Archives for Chest Disease: Vol. 92 No. 3 (2022)
- Ravi Manglani, Moshe Fenster, Theresa Henson, Ananth Jain, Neil Schluger, Clinical characteristics, imaging, and lung function among patients with persistent dyspnea of COVID-19: a retrospective observational cohort study , Monaldi Archives for Chest Disease: Early Access
- Manas Pratim Roy, Risk factors for Covid-19 in India , Monaldi Archives for Chest Disease: Vol. 92 No. 2 (2022)
- Carlo Iadevaia, Fabio Perrotta, Grazia Mazzeo, Francesco Saverio Cerqua, Gennaro Mazzarella, Salvatore Guarino, Roberto Parrella, Andrea Bianco, Incidental diagnosis of lung adenocarcinoma following coronavirus OC 43 severe pneumonia , Monaldi Archives for Chest Disease: Vol. 90 No. 3 (2020)
You may also start an advanced similarity search for this article.
