Takotsubo Cardiomyopathy and COVID-19: A Case Report and Literature Review

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Takotsubo cardiomyopathy associated with COVID-19 (n=71). Intervention: COVID-19 infection associated with Takotsubo cardiomyopathy. Primary outcome: In-hospital clinical outcome (discharge vs death).

Q: What does this research mean for the field?

Takotsubo cardiomyopathy in COVID-19 patients is frequently complicated by heart failure (59.2%), cardiogenic shock (33.8%), and has an associated mortality rate of 18.3%. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Edgar Francisco Carrizales‐Sepúlveda; Ramiro Flores‐Ramírez; José Gabriel Solís; Raymundo Vera‐Pineda; Eliu Jefte Morales-Rendón; José de Jesús Ortiz-Corona

doi:10.2174/1573403x18666220818155039

August 19, 2022Current Cardiology ReviewsOpen Access

Takotsubo Cardiomyopathy and COVID-19: A Case Report and Literature Review

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Key result

Takotsubo cardiomyopathy with COVID-19 carries an ~18% in-hospital mortality rate and frequent cardiogenic shock.

n=71

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Why the study?

Takotsubo cardiomyopathy is a reported complication of COVID-19 that can resemble an ACS and progress to acute heart failure and cardiogenic shock, requiring a high index of suspicion for accurate diagnosis and management.

Key Points

To describe a case of Takotsubo cardiomyopathy complicated by cardiogenic shock in severe COVID-19 and review the clinical presentation, diagnosis, and outcomes across published literature.
Presents a case of a 62-year-old woman with severe COVID-19 pneumonia undergoing mechanical ventilation who developed sudden hemodynamic collapse.
Conducted a literature review identifying 71 subjects across 35 published reports of Takotsubo cardiomyopathy associated with COVID-19.
Extracted patient demographics, cardiovascular risk factors, clinical presentations, electrocardiographic abnormalities, echocardiographic patterns, and mortality rates.
Across 71 reviewed subjects (median age 67 years), the median time to Takotsubo presentation was 5 days after COVID-19 diagnosis, with dyspnea (43%) and chest pain (11.3%) as the most frequent initial symptoms.
Complications were frequent, with 59.2% developing heart failure and 33.8% developing cardiogenic shock; elevated cardiac troponin was reported in 81.7% and ST-elevation in 33.8%.
Coronary angiography was performed in only 22.5% of reported cases; regarding overall survival, 52% of patients were successfully discharged, 18.3% died, and outcomes were unrecorded in 29.6%.

Study Design

Type

Case Report (n=71)

Structured PICO

P

Population

71 patients from 35 published reports (median age 67 years, 36.6% female, 36.6% male, 26.8% unspecified) plus 1 case report of a 62-year-old woman with COVID-19 complicated by Takotsubo cardiomyopathy.

E

Exposure

Case report: IV dexamethasone, invasive mechanical ventilation, vasopressor support, and levosimendan. Literature review: heterogeneous medical management for COVID-19 and Takotsubo cardiomyopathy.

O

Outcome

Clinical presentation, diagnostic characteristics, and clinical outcomes (successful discharge vs mortality) of COVID-19-associated Takotsubo cardiomyopathy.hard clinical

Takotsubo cardiomyopathy is a life-threatening complication of severe COVID-19 that frequently leads to acute heart failure and cardiogenic shock, requiring prompt echocardiographic and angiographic evaluation.

Limitations

High heterogeneity in the reported cases and available clinical details
33 of the available cases lacked information regarding clinical presentation
Left ventricular ejection fraction was not reported in over half of the available subjects
Coronary angiography was performed in only 22.5% of cases, making it impossible to reliably rule out significant obstructive coronary artery disease
Clinical outcome was not reported in 29.6% of cases
High heterogeneity in the reported cases and the details available in many reports
Thirty-three of the available cases did not have information regarding clinical presentation
LV ejection fraction was not reported in over half of the available subjects
Coronary angiography was performed in just 22.5% of cases reported in the literature, making it impossible to rule out significant atherosclerotic disease
Clinical outcome was not reported in 29.6% of patients

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Implication

High complication rates in COVID-19 Takotsubo warrant vigilance; leaves open optimal management pending prospective data.

Abstract

BACKGROUND: Takotsubo 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 PRESENTATION: It 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. CONCLUSION: We also present a detailed literature review regarding the relationship between COVID-19 and Takotsubo cardiomyopathy.

Discussion

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Cite This Study

Carrizales‐Sepúlveda et al. (2022) conducted a case report in Takotsubo cardiomyopathy associated with COVID-19 (n=71). COVID-19 infection associated with Takotsubo cardiomyopathy was evaluated on In-hospital clinical outcome (discharge vs death). Takotsubo cardiomyopathy in 71 reviewed COVID-19 patients was complicated by heart failure in 59.2%, cardiogenic shock in 33.8%, and an 18.3% mortality rate.

synapsesocial.com/papers/6a90134ef6f1ee21d5278852 https://doi.org/10.2174/1573403x18666220818155039

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Takotsubo Cardiomyopathy and COVID-19: A Case Report and Literature Review

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Takotsubo Cardiomyopathy and COVID-19: A Case Report and Literature Review

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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