Takotsubo Cardiomyopathy: A COVID-19 Complication

Eftekharzadeh, Pejmahn; Patel, Ankit; Sokolova, E F; Rodas, Aaron; Ahmed, Sibtain

doi:10.7759/cureus.22803

Cited by 5 publications

(6 citation statements)

References 15 publications

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“…After applying the eligibility criteria and title and abstract review followed by detailed evaluations, 67 articles were selected. 4 , 5 , 9 , 11 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , ...…”

Section: Resultsmentioning

confidence: 99%

Takotsubo syndrome and COVID‐19: A systematic review

Ghasemi

Kazemian

Nejadghaderi

et al. 2022

Health Science Reports

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Background and Aims Takotsubo syndrome (TTS), also known as stress cardiomyopathy, is characterized by acute and transient left ventricular dysfunction and has increased during the COVID‐19 pandemic. Herein, we aim to review studies on TTS that were associated with COVID‐19 infection, vaccine, and other COVID‐19‐related etiologies including psychosocial stressors. Methods We systematically searched PubMed, EMBASE, and Scopus up to May 12, 2022. We included case reports, case series, and original articles that reported at least one TTS case associated with COVID‐19, or TTS cases after receiving COVID‐19 vaccines, or TTS cases secondary to psychological stress due to the COVID‐19 pandemic. The quality assessment was conducted using the Joanna Briggs Institute checklist. Results Sixty‐seven articles including 102 cases were included. Hypertension was the most frequently accompanying comorbidity ( N = 67 [65.6%]) and the mean left ventricular ejection fraction was 36.5%. Among COVID‐19 patients, the in‐hospital mortality rate was 33.3%. On the other hand, only one COVID‐19‐negative individual expired (2.3%). The most common presenting clinical symptom was dyspnea in 42 (73.6%) patients. the mean time interval from the first symptom to admission was 7.2 days. The most common chest imaging finding was ground‐glass opacity which was reported in 14 (31.1%) participants. The most common abnormalities were T‐wave inversion in 35 (43.2%) and ST‐segment elevation in 30 (37%). Brain natriuretic peptide and troponin were elevated in 94.7% and 95.9% of participants, respectively. Conclusion The TTS in patients with COVID‐19 is almost rare, whereas it could lead to a great mortality and morbidity. An individual with COVID‐19, especially an elderly woman, presented with dyspnea in addition to a rise in brain natriuretic peptide and troponin should be evaluated for TTS.

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Section: Resultsmentioning

confidence: 99%

Takotsubo syndrome and COVID‐19: A systematic review

Ghasemi

Kazemian

Nejadghaderi

et al. 2022

Health Science Reports

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“…It is tempting to speculate that the temperature dysregulation and hot flushes in post-menopausal women may be an additional trigger for the syndrome. Furthermore, there have been increasing reports of TTS associated with COVID ( 22 ), and an early review has suggested that the morbidity and mortality of TTS may be exacerbated when superimposed on the hyper-inflammatory COVID background ( 23 ).…”

Section: Discussionmentioning

confidence: 99%

Hyperthermia as a trigger for Takotsubo syndrome in a rat model

Tranter

Redfors

Couch

et al. 2022

Front. Cardiovasc. Med.

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Takotsubo syndrome is a well-characterized cause of acute yet reversible heart failure associated with periods of intense emotional stress, often mimicking on presentation an acute coronary syndrome. Animal models of Takotsubo syndrome have been developed, either through the application of a stressor, or administration of exogenous catecholamine. We found that in a model of isoproterenol-induced Takotsubo syndrome in anesthetized rats hyperthermia (40–41°C) would occur after the administration of isoproterenol. Maintenance of this hyperthermia would result in an apical hypocontractility typical of the syndrome, whereas prevention of hyperthermia with active cooling to maintain a euthermic core body temperature prevented (but did not subsequently reverse) apical hypocontractility. In vitro experimentation with isolated cardiomyocytes showed no effect of hyperthermia on either baseline contractility or contractility change after beta-adrenoceptor stimulation. We suggest that the rise in body temperature that is characteristic of catecholamine storm may be a component in the development of Takotsubo syndrome.

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“…Os estudos mostraram aumento da incidência da STT na população geral e em pacientes com COVID-19 (Eftekharzadeh et al, 2022). No entanto, sua apresentação parece divergir do padrão pré-pandêmico.…”

Section: Epidemiologiaunclassified

“…Além disso, estudos sugerem uma ação direta do SARS-CoV-2 nos microvasos, por meio dos receptores da enzima conversora de angiotensina 2 (ACE-2) do hospedeiro (Varga et al, 2020). Os receptores ACE-2 são altamente expressos no tecido cardiovascular de mamíferos, incluindo células endoteliais, cardiomiócitos, fibroblastos e células musculares lisas (Eftekharzadeh et al, 2022). Uma vez que o vírus se liga a esses receptores no endotélio pode desregular as vias fisiológicas normais, causando um acúmulo de angiotensina II, consequentemente, vasoconstrição, estresse oxidativo e inflamação.…”

Section: Fisiopatologiaunclassified

“…No contexto da pandemia da COVID-19, a síndrome de Takotsubo tem sido relatada em 2 cenários diferentes: como complicação direta da infecção por SARS-CoV-2 e como consequência do estresse emocional causado pela pandemia e pelo isolamento social (Eftekharzadeh et al, 2022;Rivers et al, 2020). Os primeiros casos da cardiomiopatia de Takotsubo associada à COVID-19 foram descritos durante a fase aguda da doença, com um padrão típico de balonamento apical.…”

Section: Introductionunclassified

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Takotsubo syndrome in the context of the COVID-19 pandemic: An integrative review

Santos

Burgos

Nobre

et al. 2022

RSD

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Introduction: Takotsubo syndrome (TTS) is characterized by a temporary left ventricular (LV) systolic dysfunction, usually in the context of acute physical or emotional stress. Thus, the stress mechanism generated by the pandemic and the COVID-19 infection has been related to this syndrome. Objective: To analyze, through a literature review, the relationship between COVID-19 and Takotsubo Syndrome, taking into account the pathophysiological mechanisms involved. Methods: This is a literature review with searches performed in July 2022, using the PubMed database. Results and Discussion: 29 articles were selected, after full evaluation, the main findings show an increase in the incidence of TTS in the general population and in patients with COVID-19. The pathophysiological mechanisms involved include the increase in catecholamines and cortisol, cytokine storm, microvascular dysfunction and the direct action of SARS-COV-2 on cardiomyocytes and endothelium, in addition to the psychological burden resulting from the pandemic. Conclusion: The incidence of stress-induced cardiomyopathy is expected to increase in the general population, driven by the psychosocial consequences of this period. Therefore, it is imperative that clinicians are familiar with the clinical presentation, possible complications, and management of TTS.

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Takotsubo Cardiomyopathy: A COVID-19 Complication

Cited by 5 publications

References 15 publications

Takotsubo syndrome and COVID‐19: A systematic review

Takotsubo syndrome and COVID‐19: A systematic review

Hyperthermia as a trigger for Takotsubo syndrome in a rat model

Takotsubo syndrome in the context of the COVID-19 pandemic: An integrative review

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