Jornal de Pesquisa Clínica

Takotsubo Syndrome during the COVID Era: More Stressful Events or an Unclear Bond?

Abstract

Lucia Barbieri, Domitilla Gentile, Gabriele Tumminello, Barbara Conconi, and Stefano Carugo

‘Takotsubo syndrome’ is a cardiomyopathy characterized by a temporary wall motion abnormality of the left ventricle which shares common features with acute coronary syndrome. During the COVID-19 pandemic acute coronary syndrome can be one of the initial presentations of COVID-19 infection, ranging from a ST elevation myocardial infarction to Takotsubo cardiomyopathy. We elaborate a review of the existing literature until the April 27, 2021, in order to analyze and explore the connections between Takotsubo Cardiomyopathy and the COVID-19 pandemic. We selected twenty-seven case reports/case series and three studies. The analyzed cases include 53 patients, 19 male (36%). Shared clinical features are hypertension, diabetes mellitus and dyslipidemia. The majority were COVID-19 positive, 23 requiring mechanical ventilation. A recovered cardiac function has been described in 20 patients. In COVID-19 patients, therapy involves the use of hydroxychloroquine in 15 subjects and chloroquine in one of them. Coronary angiography was not ever performed, according to clinical instability and less-probably different diagnosis. The most type of Takotsubo syndrome was the typical one, even if inverted, biventricular and atypical were reported. The overall analysis shows a higher prevalence of male patients compared to the known literature and higher rates of clinical features such as hypertension, diabetes mellitus and dyslipidemia. An increased psychological distress, the cytokine storm, augmented adrenergic responses and microvascular dysfunction heave been hypothesized playing a role. Our study explores what the existing literature offers and clarify the importance of an accurate and immediate recognition of Takotsubo syndrome during a stressful period like the COVID pandemic.