Abstract | November 8, 2021
Takotsubo Cardiomyopathy: A COVID-19 Complication
Learning Objectives
- Describe Takotsubo Cardiomyopathy (TSCM) as a stress cardiomyopathy that presents as apical ballooning with midventricular hypercontractility that is precipitated by a physical and/or emotional stress.
- Recognize the physical stress COVID-19 places on the body and its role in causing hypoxia.
- Identify emotional stress such as agitation, restlessness and encephalopathy in COVID-19 patients as these can synergistically trigger TSCM in hypoxic patient.
Introduction: COVID-19 has been associated with pulmonary complications but does affect other organs such as the heart. Currently, COVID-19 can cause arrhythmias, heart failure (HF), acute coronary syndromes (ACS) and more. Takotsubo Cardiomyopathy (TSCM) is a cardiomyopathy precipitated by physical and/or emotional stress and can be an uncommon complication COVID-19.
Case Presentation: A 94-year-old female with PMHx of Anxiety Disorder presents to the ER complaining of respiratory distress. She tested positive for COVID-19 one week prior after developing generalized fatigue with an exposure to COVID-19. She was instructed to self-quarantine and monitor for worsening symptoms. One week later, she developed respiratory distress thus presenting to the ER. On physical exam, BP 196/93, HR 118, temperature 99.8°F, respirations 46 and oxygenating 96% with nonrebreather-mask. She appeared in distress, restless and encephalopathic. Cardiovascular exam showed a regular rhythm tachycardia without murmurs or JVD. Pulmonary exam displayed rales and rhonchi with accessory muscle use. Differential diagnosis included COVID-19, pulmonary embolism, HF, ACS, arrhythmia, and panic attack. Chest x-ray showed clear lungs, without pleural effusion or infiltrates. Initial EKG showed NSR without ST-changes. Peak troponin 0.188 (range 0.000-0.060). NT-proBNP 1,874.
Working diagnosis: Worsening COVID-19 pneumonia.
Management: She was placed on Bipap for oxygen support and monitored in the ICU. She continued being agitated and restless. Due to severe hypoxia on Bipap, her home PO medication, sertraline, was held. On day two, telemetry showed abrupt tachycardia. STAT EKG showed: rate 162 with ST-elevations in leads II, III, aVF & V5. Troponins of 4.237. STEMI alert called, and patient went for emergent cardiac catheterization. Cardiac catheterization demonstrated patent coronary vessels but showed apical hypokinesis and midventricular hypercontractility consistent with TSCM. No interventions done. The physical hypoxia from pneumonia combined with emotional stress from Anxiety disorder, sertraline being held and wearing Bipap triggered TSCM in this patient.
