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.