Takotsubo Cardiomyopathy: A COVID-19 Complication

Figure 1. Initial EKG on presentation shows normal sinus rhythm without ST changes QTc: 454. aVR: augmented vector right, aVL: augmented vector left, aVF: augmented vector foot.

Figure 2. EKG showing sinus tachycardia without any acute ST changes aVR: augmented vector right, aVL: augmented vector left, aVF: augmented vector foot.

Figure 3. EKG showing rate of 163 with ST segment elevation in inferior lateral leads II, III, aVF, and V5 aVR: augmented vector right, aVL: augmented vector left, aVF: augmented vector foot.

Figure 4. Left cardiac catheterization showing an approximately 40% proximal to mid-LAD lesion Yellow arrows show mid-LAD lesion. LAD: left anterior descending.

Figure 5. Cardiac catheterization during diastole showing myocardial tissue relaxation White arrows show left ventricle in diastole.

Figure 6. Cardiac catheterization during systole with basal hypercontraction and apical left ventricular (LV) ballooning out Gold arrows show basal hypercontraction. White arrows show apical ballooning.

Figure 7. EKG status postcardiac catheterization showing persistent ST elevations in inferior and lateral lead distribution Black arrows show ST elevations in inferior leads. Green arrows show ST elevations in lateral leads. aVR: augmented vector right, aVL: augmented vector left, aVF: augmented vector foot.

Figure 8. Pathogenesis of TSCM α-receptors cause contraction of coronary arteries inducing ischemia on cardiac membrane, while β1- and β2-receptors cause an increase in oxygen demand and increase in mechanical wall stress. Gray/purple arrows indicate cardiac chamber morphological changes during TSCM. TSCM: Takotsubo cardiomyopathy, LV: left ventricle.

Figure 9. More β1-receptors on the left ventricular base that are innervated by norepinephrine to induce hypercontraction by triggering the G-protein stimulatory pathway More β2-receptors on the cardiac apex are innervated by epinephrine that triggers the G-protein inhibitory pathway, producing apical akinesia. β1: beta-1 receptors that undergo G-protein stimulatory intervention on basal left ventricle when innervated by norepinephrine. β2: beta-2 receptors that undergo G-protein inhibitory intervention on apical left ventricle when innervated by epinephrine. White outlined arrows indicate basal hypercontraction. Black outlined arrows indicate apical akinesia.