Differential diagnostics of takotsubo syndrome and acute myocardial infarction against the background of a new COVID-19 coronavirus infection
AbstractTakotsubo syndrome is an acutely occurring heart failure syndrome characterized by transient systolic dysfunction and extensive akinesia of the apical and/or middle segments of the left ventricle (LV). Its clinical significance lies in the similarity of the clinical picture with the manifestations of acute coronary syndrome, however, with this pathology, myocardial dysfunction is completely reversible. Amid the coronavirus infection pandemic, there are more and more observations of the takotsubo syndrome associated with COVID-19. As trigger mechanisms, a large reactivity of the myocardium in the apical region to sympathetic stimulation in combination with abnormal vascular reactivity caused directly by the virus is considered.
In the presented case, a 65-year-old patient was admitted to the hospital with symptoms of coronavirus infection COVID-19. During hospitalization, he developed an episode of anginal pain, a significant troponin I level increase in the blood was revealed, and changes in the form of inversion of T waves along the anterolateral wall of the LV were visualized on the electrocardiogram. Coronoventriculography revealed a zone of akinesia of the LV apex in the absence of significant damage to the coronary arteries. Several days later, laboratory, electro- and echocardiographic changes completely regressed.
Keywords:takotsubo cardiomyopathy, clinical case, broken heart syndrome
Funding. The study had no sponsor support.
Conflict of interests. The authors declare no conflict of interests.
For citation: Ustinova E.S., Jakovlev A.A., Marzaeva E.V., Sergeev A.S. Differential diagnostics of takotsubo syndrome and acute myocardial infarction against the background of a new COVID-19 coronavirus infection. Kardiologiya: novosti, mneniya, obuchenie [Cardiology: News, Opinions, Training]. 2021; 9 (1): 59-64. DOI: https://doi.org/10.33029/2309-1908-2021-9-1-59-64 (in Russian)
References
1. Current understanding of Takotsubo syndrome: the main provisions of the published expert opinion of the working group of the Association of Heart Failure Specialists of the European Society of Cardiology. Part I. Dokazatel’naya meditsina [Evidence-Based Cardiology]. 2016; 9 (2): 26–35. (in Russian)
2. Wan S.-H., Liang J.J. Takotsubo cardiomyopathy: etiology, diagnosis, and optimal management Kardiologiya: novosti, mneniya, obuchenie [Cardiology: News, Opinions, Training]. 2015; 1 (4): 8–16. (in Russian)
3. Matveeva M.G., Gogin G.E., Alekhin M.N. Takotsubo cardiomyopathy: case report. Klinicheskaya meditsina [Clinical Medicine]. 2017; 95 (7): 663–8. DOI: http://doi.org/10.18821/0023-2149-2017-95-7-663-668 (in Russian)
4. Nedogoda S.V. Cardiovascular pathology and COVID-19: briefly on the main. Consilium Medicum. 2020; 22 (5): 19–21. DOI: http://doi.org/10.26442/20751753.2020.5.200157 (in Russian)
5. Suspitsyna I.N., Sukmanova I.A. Takotsubo syndrome. Clinical and pathogenetic aspects. Basics of diagnosis and treatment. Kardiologiya [Cardiology]. 2020; 60 (2): 96–103. DOI: https://doi.org/10.18087/cardio.2020.2.n521 (in Russian)