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Case Report: Takotsubo Syndrome Associated With Novel Coronavirus Disease 2019
Background: Takotsubo cardiomyopathy is triggered by emotional or physical stress. It is defined as a reversible myocardial dysfunction, usually with apical ballooning aspect due to apical akinesia associated with hyperkinetic basal left ventricular contraction. Described in cases of viral infection...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Frontiers Media S.A.
2021
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7937625/ https://www.ncbi.nlm.nih.gov/pubmed/33693034 http://dx.doi.org/10.3389/fcvm.2021.614562 |
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author | Ortuno, Sofia Jozwiak, Mathieu Mira, Jean-Paul Nguyen, Lee S. |
author_facet | Ortuno, Sofia Jozwiak, Mathieu Mira, Jean-Paul Nguyen, Lee S. |
author_sort | Ortuno, Sofia |
collection | PubMed |
description | Background: Takotsubo cardiomyopathy is triggered by emotional or physical stress. It is defined as a reversible myocardial dysfunction, usually with apical ballooning aspect due to apical akinesia associated with hyperkinetic basal left ventricular contraction. Described in cases of viral infections such as influenza, only few have been reported associated with novel coronavirus disease 2019 (COVID-19) in the recent pandemic. Case summary: A 79-years-old man, with cardiovascular risk factors (type 2 diabetes and hypertension) and chronic kidney disease, presented to the emergency room for severe dyspnea after 8 days of presenting respiratory symptoms and fever. Baseline electrocardiogram (ECG) was normal, but he presented marked inflammatory syndrome. He was transferred to an intensive care unit to receive mechanical ventilation within 6 h, due to acute respiratory distress syndrome. He presented circulatory failure 2 days after, requiring norepinephrine support (up to up to 1.04 μg/kg/min). Troponin T was elevated (637 ng/l). ECG showed diffuse T wave inversion. Echocardiography showed reduced left ventricular ejection fraction (LVEF 40%), with visual signs of Takotsubo cardiomyopathy. Cardiac failure resolved after 24 h with troponin T decrease (433 ng/l) and restoration of cardiac function (LVEF 60% with regression of Takotsubo features). Patient died after 15 days of ICU admission, due to septic shock from ventilator-acquired pneumonia. Cardiac function was then normal. Conclusion: Mechanisms of Takotsubo cardiomyopathy in viral infections include catecholamine-induced myocardial toxicity and inflammation related to sepsis. Differential diagnoses include myocarditis and myocardial infarction. Evidence of the benefit of immunomodulatory drugs and dexamethasone are growing to support this hypothesis in COVID-19. |
format | Online Article Text |
id | pubmed-7937625 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-79376252021-03-09 Case Report: Takotsubo Syndrome Associated With Novel Coronavirus Disease 2019 Ortuno, Sofia Jozwiak, Mathieu Mira, Jean-Paul Nguyen, Lee S. Front Cardiovasc Med Cardiovascular Medicine Background: Takotsubo cardiomyopathy is triggered by emotional or physical stress. It is defined as a reversible myocardial dysfunction, usually with apical ballooning aspect due to apical akinesia associated with hyperkinetic basal left ventricular contraction. Described in cases of viral infections such as influenza, only few have been reported associated with novel coronavirus disease 2019 (COVID-19) in the recent pandemic. Case summary: A 79-years-old man, with cardiovascular risk factors (type 2 diabetes and hypertension) and chronic kidney disease, presented to the emergency room for severe dyspnea after 8 days of presenting respiratory symptoms and fever. Baseline electrocardiogram (ECG) was normal, but he presented marked inflammatory syndrome. He was transferred to an intensive care unit to receive mechanical ventilation within 6 h, due to acute respiratory distress syndrome. He presented circulatory failure 2 days after, requiring norepinephrine support (up to up to 1.04 μg/kg/min). Troponin T was elevated (637 ng/l). ECG showed diffuse T wave inversion. Echocardiography showed reduced left ventricular ejection fraction (LVEF 40%), with visual signs of Takotsubo cardiomyopathy. Cardiac failure resolved after 24 h with troponin T decrease (433 ng/l) and restoration of cardiac function (LVEF 60% with regression of Takotsubo features). Patient died after 15 days of ICU admission, due to septic shock from ventilator-acquired pneumonia. Cardiac function was then normal. Conclusion: Mechanisms of Takotsubo cardiomyopathy in viral infections include catecholamine-induced myocardial toxicity and inflammation related to sepsis. Differential diagnoses include myocarditis and myocardial infarction. Evidence of the benefit of immunomodulatory drugs and dexamethasone are growing to support this hypothesis in COVID-19. Frontiers Media S.A. 2021-02-22 /pmc/articles/PMC7937625/ /pubmed/33693034 http://dx.doi.org/10.3389/fcvm.2021.614562 Text en Copyright © 2021 Ortuno, Jozwiak, Mira and Nguyen. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Cardiovascular Medicine Ortuno, Sofia Jozwiak, Mathieu Mira, Jean-Paul Nguyen, Lee S. Case Report: Takotsubo Syndrome Associated With Novel Coronavirus Disease 2019 |
title | Case Report: Takotsubo Syndrome Associated With Novel Coronavirus Disease 2019 |
title_full | Case Report: Takotsubo Syndrome Associated With Novel Coronavirus Disease 2019 |
title_fullStr | Case Report: Takotsubo Syndrome Associated With Novel Coronavirus Disease 2019 |
title_full_unstemmed | Case Report: Takotsubo Syndrome Associated With Novel Coronavirus Disease 2019 |
title_short | Case Report: Takotsubo Syndrome Associated With Novel Coronavirus Disease 2019 |
title_sort | case report: takotsubo syndrome associated with novel coronavirus disease 2019 |
topic | Cardiovascular Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7937625/ https://www.ncbi.nlm.nih.gov/pubmed/33693034 http://dx.doi.org/10.3389/fcvm.2021.614562 |
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