Conclusions:
Stress cardiomyopathy or Takotsubo cardiomyopathy is characterized by
transient left ventricular dysfunction in response to an emotional or
physical stressor (11). Stress cardiomyopathy has been implicated in
about 1-2% of patients diagnosed with acute coronary syndromes. Among
different demographic groups, post-menopausal women are most frequently
affected, which is attributed to increased prevalence of co-morbid
depression, anxiety, sleep disturbances and an increased sympathetic
drive in this population (11).
The ongoing viral pandemic has had far-reaching consequences on the
physical, economical and emotional well-being of millions of individuals
across the world. A recent retrospective study confirmed an increase in
the incidence of stress cardiomyopathy during the pandemic, about
four-fold, compared to pre-pandemic era, likely due to increased
emotional stress from the spreading pandemic, deaths and economic crisis
(10). This cardiomyopathy has been shown to occur in patients who tested
negative for the novel coronavirus and hence, is independent of COVID’s
effect on the cardiovascular system.
In this case series, we present two such cases of Takotsubo
cardiomyopathy triggered by heightened emotional stress during the
pandemic, in the most vulnerable demographic group- post-menopausal
women. While the first patient lived along, with family in a distant
state and suffered from worsening of her anxiety due to quarantine and
social distancing, the second patient presented in this case series had
increased emotional stress because of health issues and finding it
difficult to navigate the health system during the pandemic. Both fell
prey to stress cardiomyopathy, as an indirect consequence of the ongoing
pandemic. In addition to the stress related to the pandemic, ongoing
political tensions and demonstrations related to racial inequality, may
have contributed.
Stress cardiomyopathy can be associated with in-hospital mortality as
high as 5%, with complications ranging from cardiogenic shock, left
ventricular outflow obstruction, malignant arrythmias, systemic
thrombo-embolism and rarely ventricular rupture (11). With the vaccine
for SARS-CoV-2 virus still not in immediate sight, the time-course for
this pandemic is unpredictable. With the essential social distancing
measures in place, elderly population may not have adequate family
support in these difficult times and are at an increased risk for
stress- related comorbidities. Further, in addition to direct
cardiovascular effects of the novel coronavirus in the form of
conduction disturbances, arrhythmias, myocarditis, atherosclerotic
plaque rupture, coronary and pulmonary emboli; health care providers
need to cognizant of the emotional ramifications of the ongoing pandemic
in the form of increased risk of Takotsubo cardiomyopathy. Hence, urgent
measures need to be taken to help at-risk population cope with the
ongoing stressors, provide psychiatric care and psychological counseling
through tele-health, to help decrease the incidence of this
cardiomyopathy.