An Interesting Case of COVID-19 Induced Reversed Takotsubo Cardiomyopathy and Insight on Cardiac Biomarkers

Cardiovascular involvement is common in COVID-19 patients and is associated with increased mortality, especially in patients with pre-existing cardiac comorbidities. Elevated levels of troponin have been noted to predict worse prognosis for COVID-19 patients, regardless the physiology of insult. We report a case of a 65-year old man who was admitted for acute hypoxemic respiratory failure due to COVID-19 disease that rapidly decompensated and required mechanical ventilation. He responded well with medical treatment and was successfully extubated. Interestingly, his serum troponin T levels remained negative (<0.01 ng/mL) until day 10, when it was noted to be elevated despite him being completely asymptomatic. Echocardiogram revealed new left ventricular wall motion abnormalities suggestive of reverse Takotsubo cardiomyopathy. Unfortunately, he suffered from a pulseless electrical arrest less than 24 hours later and eventually expired. This case shows that a policy of trending troponin levels may be valuable as a screening tool for critically ill COVID-19 patients and may be beneficial for early silent validation of cardiovascular involvement in these patients, who could otherwise be asymptomatic yet presage adverse clinical events. Moreover, using troponin as a screening tool may lead to decreased utilization of echocardiography and reduce the exposure of COVID-19 to healthcare workers.