Stress cardiomyopathy in patients with COVID-19 infection

Background: COVID-19 pandemic has been the most widespread pandemic in the last century. 8% of COVID-19 patients have some sort of cardiac injury. Only sporadic case reports and case series have been published addressing stress cardiomyopathy in this patient population. We reviewed the clinical presentation, pathogenesis, and outcomes of stress cardiomyopathy in patients with COVID-19 infection.

Methods: We did a key-word search through PubMed and MEDLINE for stress cardiomyopathy and COVID-19 published between December 1, 2019 and November 1, 2020. We included all case reports and case series of stress cardiomyopathy in patients who tested positive for COVID-19.

Results: We found 37 patients, 43.25% were males. 21.6% presented with chest pain and 90% had elevated troponin during the illness. ECG changes included T wave inversion in 37.4% and ST segment elevation in 35% of patients. Coronary angiography when pursued was negative for obstructive coronary artery disease. The diagnosis was confirmed by decreased left ventricular systolic function (</=45%) and wall motion abnormalities on echocardiography or ventriculography. 68% had the typical Takotsubo pattern, while reverse-Takotsubo pattern was observed in 19% of patients. 8% patients had global/ biventricular hypokinesia and 5% were found to have a mid-ventricular variant. 73% of reported patients recovered completely from COVID-19.

Conclusion: Stress cardiomyopathy can be important consequence of COVID-19 infection. High index of suspicion is crucial for prompt diagnosis and management.