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Takotsubo cardiomyopathy caused by emotional stress associated with the Coronavirus Disease 2019 (COVID-19) pandemic
  • Devika Kir,
  • Nusen Beer,
  • Eduardo de Marchena
Devika Kir
University of Miami Miller School of Medicine
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Nusen Beer
University of Miami Miller School of Medicine
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Eduardo de Marchena
University of Miami Miller School of Medicine
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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.