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.
Pericardial decompression syndrome is a rare but potentially fatal complication following needle or surgical pericardiocentesis and should be recognized as paradoxical hemodynamic deterioration. The exact pathophysiology of pericardial decompression syndrome is unknown but is likely that several mechanisms involving hemodynamic, ischemic and autonomic imbalance lead to the clinical manifestation of this entity. There is no specific treatment for pericardial decompression syndrome other than supportive care, however, early interventions such as aggressive heart failure therapy, inotropic medications and sometimes mechanical circulatory support should be implement as mortality can be as high as 30%. We report a patient presenting with severe right ventricular failure and cardiogenic shock secondary to PDS.