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Belli O, Ardissino M, Bottiroli M, et al. Emergency cardiac imaging for coronavirus disease 2019 (COVID-19) in practice: a case of takotsubo stress cardiomyopathy. Cardiovasc Ultrasound. 2021;19(1):31doi: 10.1186/s12947-021-00251-4.
Belli, O., Ardissino, M., Bottiroli, M., Soriano, F., Blanda, C., Oreglia, J., Mondino, M., & Moreo, A. (2021). Emergency cardiac imaging for coronavirus disease 2019 (COVID-19) in practice: a case of takotsubo stress cardiomyopathy. Cardiovascular ultrasound, 19(1), 31. https://doi.org/10.1186/s12947-021-00251-4
Belli, Oriana, et al. "Emergency cardiac imaging for coronavirus disease 2019 (COVID-19) in practice: a case of takotsubo stress cardiomyopathy." Cardiovascular ultrasound vol. 19,1 (2021): 31. doi: https://doi.org/10.1186/s12947-021-00251-4
Belli O, Ardissino M, Bottiroli M, Soriano F, Blanda C, Oreglia J, Mondino M, Moreo A. Emergency cardiac imaging for coronavirus disease 2019 (COVID-19) in practice: a case of takotsubo stress cardiomyopathy. Cardiovasc Ultrasound. 2021 Aug 24;19(1):31. doi: 10.1186/s12947-021-00251-4. PMID: 34429107; PMCID: PMC8383239.
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Cardiovasc Ultrasound. 2021 Aug 24;19(1):31. doi: 10.1186/s12947-021-00251-4.

Emergency cardiac imaging for coronavirus disease 2019 (COVID-19) in practice: a case of takotsubo stress cardiomyopathy.

Cardiovascular ultrasound

Oriana Belli, Maddalena Ardissino, Maurizio Bottiroli, Francesco Soriano, Calogero Blanda, Jacopo Oreglia, Michele Mondino, Antonella Moreo

Affiliations

  1. Division, of Cardiology, 'A. De Gasperis' Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy. [email protected].
  2. Department of Medicine, Imperial College London, Exhibition Road, London, UK.
  3. Division of Anaesthetics and Intensive Care, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
  4. Division, of Cardiology, 'A. De Gasperis' Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.

PMID: 34429107 PMCID: PMC8383239 DOI: 10.1186/s12947-021-00251-4

Abstract

BACKGROUND: Cardiovascular 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.

CONCLUSION: This 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.

© 2021. The Author(s).

Keywords: COVID-19; Cardiomyopathy; Coronavirus; Stress; Tako-tsubo

References

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  4. Eur Heart J. 2020 May 14;41(19):1861-1862 - PubMed
  5. JAMA Netw Open. 2020 Jul 1;3(7):e2014780 - PubMed
  6. SN Compr Clin Med. 2020 Oct 6;:1-7 - PubMed

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