. The differential diagnosis of giant inverted T waves in the ECG includes, among others, Takotsubo syndrome (TTS). In a critically ill patient with acute hemodynamic or respiratory deterioration, a stress-related cardiomyopathy syndrome needs to be ruled out. In COVID-19 infection the main physiopathological mechanisms include systemic inflammatory response syndrome and thrombosis, which can condition cardiovascular complications. We present the case of a patient with COVID-19 infection who developed acute hemodynamic and respiratory collapse associated with giant inverted T waves in the ECG and regional wall motion abnormalities in the transthoracic echocardiogram. The resolution of these alterations after medical management supports the diagnosis of TTS caused by COVID-19 infection; to date, few cases of this association have been reported.

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Glycoprotein IIb/IIIa inhibitors are an adjuvant therapy for the treatment of patients with acute coronary syndromes. The main adverse reactions are bleeding and thrombocytopenia in 1–2% of cases. A 66-year-old woman arrived at the emergency department with ST-elevation MI. The catheterisation lab was busy, so she received thrombolytic therapy. Coronary angiography revealed a 90% stenosis in the middle segment of the left anterior descending artery and Thrombolysis in MI 2 flow. Subsequent percutaneous coronary intervention showed abundant thrombus and a coronary dissection and it was necessary to insert five drug-eluting stents. Non-fractionated heparin and a tirofiban infusion were used. After the percutaneous coronary intervention, she developed severe thrombocytopenia, haematuria and gingivorrhagia, for which infusion of tirofiban was suspended. In follow-up, no major bleeding or subsequent haemorrhagic complications were identified. It is crucial to distinguish between heparin-induced thrombocytopenia and thrombocytopenia caused by other drugs. A high level of suspicion should be employed in these cases.

A 20-year-old man was diagnosed with hypertension. What means the finding in the chest X ray of this young man with hypertension? Blood pressure was 160/100 mm Hg in both arms, and 130/80 mm Hg in the legs. A slowed upstroke of the femoral pulse with radiofemoral delay was noticed. A grade 4/6 telesystolic murmur was heard at the left sternal border irradiated to the interescapular region. The electrocardiogram showed incomplete right bundle branch block. In the chest radiograph, there was inferior rib notching (Roesler sign), predominantly on the left side; a "figure 3" sign (Fig. 1A) beneath the aortic knob was also noticed. Transthoracic echocardiogram revealed a peak systolic gradient of 50 mm Hg across the descending aorta. Computed tomography angiography showed hypoplasia of the aorta distal to the left subclavian artery and before the coarctation (which had a diameter of 4 mm), with prominent collateral circulation (Fig. 1, B-D). Balloon angioplasty and stenting was performed without complications. The "figure 3" sign usually is attributed to dilatation of the aorta above and below the coarctation. 1,2 In this case, it appears with proximal hypoplasia of the aorta, which can be present in up to 81% of cases, usually is part of the same disease spectrum, 3 and is the most definitive antenatal sign of postnatal coarctation. 4