Takotsubo cardiomyopathy caused by emotional stress associated with the
Coronavirus Disease 2019 (COVID-19) pandemic
Abstract
The COVID-19 pandemic has had far-reaching consequences beyond the
disease itself, including economic, social, political, religious and
psychological implications. This novel coronavirus has been shown to
have cardiovascular manifestations in the form of arrhythmias,
conduction disturbances, myocarditis, stress cardiomyopathy, myocardial
injury and myocardial ischemia or infarction from increased
microvascular and/or macrovascular coagulopathy. However, in addition to
these direct effects, we are now starting to recognize indirect
cardiovascular effects of COVID-19 in the form of increased incidence of
Takutsobo cardiomyopathy in patients without any evidence of coronavirus
infection. In this case series, we present two post-menopausal women,
presenting with chest pain and acute coronary syndrome, who are finally
diagnosed with stress cardiomyopathy, triggered by increased emotional
stress related to the pandemic. There is data from a retrospective
cohort analysis showing a four-fold increase in the incidence of acute
coronary syndrome resulting from stress cardiomyopathy during the
pandemic period compared to similar times periods before the pandemic.
Hence, health care providers need to cognizant of the emotional
ramifications of the ongoing pandemic in the form of increased risk of
Takotsubo cardiomyopathy. Moreover, urgent measures need to be taken to
help at-risk population cope with the ongoing stressors to help decrease
the incidence of this cardiomyopathy.