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 Table of Contents  
LETTER TO THE EDITOR
Year : 2020  |  Volume : 4  |  Issue : 2  |  Page : 57-58

Stress-induced cardiomyopathy related to SARS-CoV-2


Interventional Cardiology Unit, GVM Care and Research Maria Cecilia Hospital, Cotignola, Italy

Date of Submission04-Oct-2020
Date of Acceptance29-Apr-2020
Date of Web Publication13-Jul-2020

Correspondence Address:
Dr. A Cereda
Interventional Cardiology Unit, GVM Care and Research Maria Cecilia Hospital, Cotignola, RA
Italy
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/hm.hm_10_20

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How to cite this article:
Cereda A, Toselli M, Laricchia A, Mangieri A, Ruggiero R, Gallo F, Sticchi A, Khokhar A, Giannini F, Colombo A. Stress-induced cardiomyopathy related to SARS-CoV-2. Heart Mind 2020;4:57-8

How to cite this URL:
Cereda A, Toselli M, Laricchia A, Mangieri A, Ruggiero R, Gallo F, Sticchi A, Khokhar A, Giannini F, Colombo A. Stress-induced cardiomyopathy related to SARS-CoV-2. Heart Mind [serial online] 2020 [cited 2022 Oct 3];4:57-8. Available from: http://www.heartmindjournal.org/text.asp?2020/4/2/57/289690

The first diagnosis in Italy of coronavirus disease of 2019 (COVID-19) was performed in February 2020 with a subsequent widespread diffusion, particularly into the northern regions. Due to the worldwide detection of thousands of cases, COVID-19 was declared a pandemic by the World Health Organization on March 11, 2020, so the Italian Government established the lockdown and quarantine for positive patients and close contacts. A continuous escalation of cases and virus-related deaths has been regularly broadcast in social media. Moreover, the economic crisis caused by the discontinuation of the majority of commercial activities has impacted on the financial scenario.

We present the case of a 72-year-old woman admitted to our department for intermittent chest pain that had started a few hours before during the TV breaking news on COVID-19 pandemic. The patient was in quarantine due to recent close contact with a relative, tested positive for COVID-19. She did not have a cardiological history, but she reported untreated mixed anxiety–depressive disorder. The electrocardiogram showed a right bundle branch block masquerading evidence of myocardial ischemia, whereas the echocardiogram revealed a hypokinesis of the mid-apical segments with a mild troponin elevation. Coronary angiography was performed in a dedicated catheterization laboratory by operators wearing personal protective devices. No obstructive coronary atherosclerotic lesions were detected [Figure 1]a, [Figure 1]b, [Figure 1]c, and the ventriculography confirmed a hypokinesis of the anterior-apical segments showing a typical “apical ballooning” and hypercontractility of the basal segments [Figure 1]d, [Figure 1]e, [Figure 1]f. The RNA-based COVID-19 testing turned out to be negative 24 h later, and an echocardiogram showed a left ventricle recovery. The patient was discharged with a “stress-induced cardiomyopathy related to COVID-19 pandemic” diagnosis caused by the recent psychological stress. A strict personal telehealth follow-up was planned.
Figure 1: (a-c) Coronary angiography with no evidence of coronary obstructive lesion. (e-f) Left ventricular angiography with kinetic alterations suggestive for Takotsubo syndrome

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From the beginning of the COVID-19 pandemic, also due to an extensive mass media reporting, a higher prevalence of psychiatric and neurologic disorders has been reported in patients with stress-induced cardiomyopathy compared to those usually affected by the acute coronary syndrome. Patients distressed by anxiety–depressive disorder have an exaggerated norepinephrine response to emotional stressors, and a subset of them has an increased spillover and decreased reuptake of norepinephrine. Women with neurologic or psychiatric conditions are more prone to the development of stress-induced cardiomyopathy.[1]

During a quarantine, different stressors (fear of infection, frustration, and boredom, inadequate supplies, or information lacking) may lead to psychological, psychosomatic, and organic disorders. Moreover, financial losses can determine a severe socioeconomic impact on the population in terms of anger and anxiety that may persist several months after the quarantine.[2]

This case reflects one of the possible consequences of the COVID-19 pandemic in the noninfected population. Prolonged psychological stress, such as quarantine, in a predisposed patient, could represent a trigger for a cardiovascular event such as a stress-induced cardiomyopathy.[3]

The management of acute cardiovascular diseases can be challenging in an extraordinary emergency setting. The social and economic butterfly effect of infectious diseases, such as COVID-19, can represent a heavy psychological and physical burden for the population, regardless of the positivity itself.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ghadri JR, Wittstein IS, Prasad A, Sharkey S, Dote K, Akashi YJ,et al. International expert consensus document on takotsubo syndrome (Part I): Clinical characteristics, diagnostic criteria, and pathophysiology. Eur Heart J 2018;39:2032-46.  Back to cited text no. 1
    
2.
Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, et al. The psychological impact of quarantine and how to reduce it: Rapid review of the evidence. Lancet 2020;395:912-20.  Back to cited text no. 2
    
3.
Driggin E, Madhavan MV, Bikdeli B, Chuich T, Laracy J, Bondi-Zoccai G,et al. Cardiovascular considerations for patients, health care workers, and health systems during the coronavirus disease 2019 (COVID-19) pandemic. J Am Coll Cardiol 2020;75. pii: S0735-1097(20)34637-4.  Back to cited text no. 3
    


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