COVID-19-associated stress cardiomyopathy: Difference between revisions

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===History and Symptoms===
===History and Symptoms===
The majority of patients with [disease name] are asymptomatic.
Symptoms of stress cardiomyopathy can mimic [[acute coronary syndrome]]. The most common presenting symptoms are:<ref name="pmid191064009">{{cite journal |vauthors=Akashi YJ, Goldstein DS, Barbaro G, Ueyama T |title=Takotsubo cardiomyopathy: a new form of acute, reversible heart failure |journal=Circulation |volume=118 |issue=25 |pages=2754–62 |year=2008 |pmid=19106400 |pmc=4893309 |doi=10.1161/CIRCULATIONAHA.108.767012 |url=}}</ref><ref name="pmid182065218">{{cite journal |vauthors=Brenner ZR, Powers J |title=Takotsubo cardiomyopathy |journal=Heart Lung |volume=37 |issue=1 |pages=1–7 |year=2008 |pmid=18206521 |doi=10.1016/j.hrtlng.2006.12.003 |url=}}</ref><ref name="pmid182944736">{{cite journal |vauthors=Prasad A, Lerman A, Rihal CS |title=Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction |journal=Am. Heart J. |volume=155 |issue=3 |pages=408–17 |year=2008 |pmid=18294473 |doi=10.1016/j.ahj.2007.11.008 |url=}}</ref><ref name="pmid152761005">{{cite journal |vauthors=Bybee KA, Prasad A, Barsness GW, Lerman A, Jaffe AS, Murphy JG, Wright RS, Rihal CS |title=Clinical characteristics and thrombolysis in myocardial infarction frame counts in women with transient left ventricular apical ballooning syndrome |journal=Am. J. Cardiol. |volume=94 |issue=3 |pages=343–6 |year=2004 |pmid=15276100 |doi=10.1016/j.amjcard.2004.04.030 |url=}}</ref><ref name="pmid263325472">{{cite journal |vauthors=Templin C, Ghadri JR, Diekmann J, Napp LC, Bataiosu DR, Jaguszewski M, Cammann VL, Sarcon A, Geyer V, Neumann CA, Seifert B, Hellermann J, Schwyzer M, Eisenhardt K, Jenewein J, Franke J, Katus HA, Burgdorf C, Schunkert H, Moeller C, Thiele H, Bauersachs J, Tschöpe C, Schultheiss HP, Laney CA, Rajan L, Michels G, Pfister R, Ukena C, Böhm M, Erbel R, Cuneo A, Kuck KH, Jacobshagen C, Hasenfuss G, Karakas M, Koenig W, Rottbauer W, Said SM, Braun-Dullaeus RC, Cuculi F, Banning A, Fischer TA, Vasankari T, Airaksinen KE, Fijalkowski M, Rynkiewicz A, Pawlak M, Opolski G, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Crea F, Dichtl W, Franz WM, Empen K, Felix SB, Delmas C, Lairez O, Erne P, Bax JJ, Ford I, Ruschitzka F, Prasad A, Lüscher TF |title=Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy |journal=N. Engl. J. Med. |volume=373 |issue=10 |pages=929–38 |year=2015 |pmid=26332547 |doi=10.1056/NEJMoa1406761 |url=}}</ref><ref name="pmid280417128">{{cite journal |vauthors=Efferth T, Banerjee M, Paul NW |title=Broken heart, tako-tsubo or stress cardiomyopathy? Metaphors, meanings and their medical impact |journal=Int. J. Cardiol. |volume= |issue= |pages= |year=2016 |pmid=28041712 |doi=10.1016/j.ijcard.2016.12.129 |url=}}</ref>


OR
*[[Chest pain]] or [[chest tightness]]
*[[Shortness of breath]]
*[[Vomiting]]
*[[Loss of consciousness]] due to [[syncope]] or [[cardiac arrest]] in rare cases


The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].
When taking the history from a patient with suspected stress cardiomyopathy, it is important to ask about:<ref name="pmid182065218" /><ref name="pmid152761005" />
 
*Personal history of [[hypertension]], [[hyperlipidemia]], [[paroxysmal atrial fibrillation]], [[syncope]], [[hypoglycemia]] or [[stroke]]
*Triggering event(s) to symptoms such as an unexpected death, being a victim of domestic violence or engaging in an argument or performing strenuous [[Physical exercise|physical activity]]


===Physical Examination===
===Physical Examination===
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===X-ray===
===X-ray===
There are no x-ray findings associated with [disease name].
Takotsubo in Japanese language refer to a ceramic pot, which is used to trap octopus. The typical [[Chest X-ray|chest x-ray]] findings in patients with stress cardiomyopathy include a takotsubo-shaped [[heart]], in which there is [[apical ballooning]] and narrowing of the [[Anatomical terms of location|proximal]] portion near the [[great vessels]].
 
OR
 
An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===Echocardiography or Ultrasound===
===Echocardiography or Ultrasound===
There are no echocardiography/ultrasound  findings associated with [disease name].
The following [[echocardiographic]] findings may be seen in patients with stress cardiomyopathy:<ref name="pmid182065216">{{cite journal |vauthors=Brenner ZR, Powers J |title=Takotsubo cardiomyopathy |journal=Heart Lung |volume=37 |issue=1 |pages=1–7 |year=2008 |pmid=18206521 |doi=10.1016/j.hrtlng.2006.12.003 |url=}}</ref><ref name="pmid182944734">{{cite journal |vauthors=Prasad A, Lerman A, Rihal CS |title=Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction |journal=Am. Heart J. |volume=155 |issue=3 |pages=408–17 |year=2008 |pmid=18294473 |doi=10.1016/j.ahj.2007.11.008 |url=}}</ref><ref name="pmid197267765">{{cite journal |vauthors=Tsai TT, Nallamothu BK, Prasad A, Saint S, Bates ER |title=Clinical problem-solving. A change of heart |journal=N. Engl. J. Med. |volume=361 |issue=10 |pages=1010–6 |year=2009 |pmid=19726776 |doi=10.1056/NEJMcps0903023 |url=}}</ref><ref name="pmid280417125">{{cite journal |vauthors=Efferth T, Banerjee M, Paul NW |title=Broken heart, tako-tsubo or stress cardiomyopathy? Metaphors, meanings and their medical impact |journal=Int. J. Cardiol. |volume= |issue= |pages= |year=2016 |pmid=28041712 |doi=10.1016/j.ijcard.2016.12.129 |url=}}</ref>
 
OR
 
Echocardiography/ultrasound  may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR


There are no echocardiography/ultrasound  findings associated with [disease name]. However, an echocardiography/ultrasound  may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
*[[Apical ballooning]]
*[[Apical]] or mid-segment [[dyskinesia]] or [[akinesia]]
*[[Left ventricular]] [[systolic dysfunction]]
* Reduced [[ejection fraction]]


===CT scan===
===CT scan===
There are no CT scan findings associated with [disease name].
A cardiac [[CT scan]] can also help differentiate between stress cardiomyopathy and [[acute MI]]. Regional abnormalities in the wall motion of the [[heart]], along with absence of [[coronary atherosclerosis]] support the diagnosis of stress cardiomyopathy over an [[acute MI]].<ref name="pmid28041712" />
 
OR
 
[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===MRI===
===MRI===
There are no MRI findings associated with [disease name].


OR
*[[Cardiovascular magnetic resonance imaging (CMR)|Cardiac magnetic resonance (CMR)]] is a useful imaging modality in distinguishing between stress cardiomyopathy and [[myocarditis]] or [[MI]]. In the case of [[myocarditis]] or [[MI]], there is delayed hyper-enhancement of [[gadolinium]]. However, absence of [[gadolinium]] hyper-enhancement supports the diagnosis of stress cardiomyopathy. Also, stress cardiomyopathy results in regional wall abnormality and its extent can best be documented using [[Cardiovascular magnetic resonance imaging (CMR)|cardiac magnetic resonance]].<ref name="pmid182944735">{{cite journal |vauthors=Prasad A, Lerman A, Rihal CS |title=Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction |journal=Am. Heart J. |volume=155 |issue=3 |pages=408–17 |year=2008 |pmid=18294473 |doi=10.1016/j.ahj.2007.11.008 |url=}}</ref><ref name="pmid156871363">{{cite journal |vauthors=Sharkey SW, Lesser JR, Zenovich AG, Maron MS, Lindberg J, Longe TF, Maron BJ |title=Acute and reversible cardiomyopathy provoked by stress in women from the United States |journal=Circulation |volume=111 |issue=4 |pages=472–9 |year=2005 |pmid=15687136 |doi=10.1161/01.CIR.0000153801.51470.EB |url=}}</ref><ref name="pmid17175045">{{cite journal |vauthors=Haghi D, Fluechter S, Suselbeck T, Kaden JJ, Borggrefe M, Papavassiliu T |title=Cardiovascular magnetic resonance findings in typical versus atypical forms of the acute apical ballooning syndrome (Takotsubo cardiomyopathy) |journal=Int. J. Cardiol. |volume=120 |issue=2 |pages=205–11 |year=2007 |pmid=17175045 |doi=10.1016/j.ijcard.2006.09.019 |url=}}</ref><ref name="pmid17631086">{{cite journal |vauthors=Mitchell JH, Hadden TB, Wilson JM, Achari A, Muthupillai R, Flamm SD |title=Clinical features and usefulness of cardiac magnetic resonance imaging in assessing myocardial viability and prognosis in Takotsubo cardiomyopathy (transient left ventricular apical ballooning syndrome) |journal=Am. J. Cardiol. |volume=100 |issue=2 |pages=296–301 |year=2007 |pmid=17631086 |doi=10.1016/j.amjcard.2007.02.091 |url=}}</ref><ref name="pmid16669180">{{cite journal |vauthors=Deetjen AG, Conradi G, Mollmann S, Rad A, Hamm CW, Dill T |title=Value of gadolinium-enhanced magnetic resonance imaging in patients with Tako-Tsubo-like left ventricular dysfunction |journal=J Cardiovasc Magn Reson |volume=8 |issue=2 |pages=367–72 |year=2006 |pmid=16669180 |doi= |url=}}</ref><ref name="pmid12628715">{{cite journal |vauthors=Abe Y, Kondo M, Matsuoka R, Araki M, Dohyama K, Tanio H |title=Assessment of clinical features in transient left ventricular apical ballooning |journal=J. Am. Coll. Cardiol. |volume=41 |issue=5 |pages=737–42 |year=2003 |pmid=12628715 |doi= |url=}}</ref><ref name="pmid15687123">{{cite journal |vauthors=Dec GW |title=Recognition of the apical ballooning syndrome in the United States |journal=Circulation |volume=111 |issue=4 |pages=388–90 |year=2005 |pmid=15687123 |doi=10.1161/01.CIR.0000155234.69439.E4 |url=}}</ref><ref name="pmid19944334">{{cite journal |vauthors=Handy AD, Prasad A, Olson TM |title=Investigating genetic variation of adrenergic receptors in familial stress cardiomyopathy (apical ballooning syndrome) |journal=J Cardiol |volume=54 |issue=3 |pages=516–7 |year=2009 |pmid=19944334 |doi=10.1016/j.jjcc.2009.08.008 |url=}}</ref><ref name="pmid19167638">{{cite journal |vauthors=Sharkey SW, Maron BJ, Nelson P, Parpart M, Maron MS, Bristow MR |title=Adrenergic receptor polymorphisms in patients with stress (tako-tsubo) cardiomyopathy |journal=J Cardiol |volume=53 |issue=1 |pages=53–7 |year=2009 |pmid=19167638 |doi=10.1016/j.jjcc.2008.08.006 |url=}}</ref><ref name="pmid21771988">{{cite journal |vauthors=Eitel I, von Knobelsdorff-Brenkenhoff F, Bernhardt P, Carbone I, Muellerleile K, Aldrovandi A, Francone M, Desch S, Gutberlet M, Strohm O, Schuler G, Schulz-Menger J, Thiele H, Friedrich MG |title=Clinical characteristics and cardiovascular magnetic resonance findings in stress (takotsubo) cardiomyopathy |journal=JAMA |volume=306 |issue=3 |pages=277–86 |year=2011 |pmid=21771988 |doi=10.1001/jama.2011.992 |url=}}</ref><ref name="pmid18820322">{{cite journal |vauthors=Eitel I, Behrendt F, Schindler K, Kivelitz D, Gutberlet M, Schuler G, Thiele H |title=Differential diagnosis of suspected apical ballooning syndrome using contrast-enhanced magnetic resonance imaging |journal=Eur. Heart J. |volume=29 |issue=21 |pages=2651–9 |year=2008 |pmid=18820322 |doi=10.1093/eurheartj/ehn433 |url=}}</ref>
*[[Cardiovascular magnetic resonance imaging (CMR)|CMR]] in stress cardiomyopathy shows absence of irreversible damage and segmental [[LV dysfunction]].<ref name="pmid17631086" />


[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
Other findings on [[CMR]] include:<ref name="pmid280417126">{{cite journal |vauthors=Efferth T, Banerjee M, Paul NW |title=Broken heart, tako-tsubo or stress cardiomyopathy? Metaphors, meanings and their medical impact |journal=Int. J. Cardiol. |volume= |issue= |pages= |year=2016 |pmid=28041712 |doi=10.1016/j.ijcard.2016.12.129 |url=}}</ref><ref name="pmid20117439">{{cite journal |vauthors=Sharkey SW, Windenburg DC, Lesser JR, Maron MS, Hauser RG, Lesser JN, Haas TS, Hodges JS, Maron BJ |title=Natural history and expansive clinical profile of stress (tako-tsubo) cardiomyopathy |journal=J. Am. Coll. Cardiol. |volume=55 |issue=4 |pages=333–41 |year=2010 |pmid=20117439 |doi=10.1016/j.jacc.2009.08.057 |url=}}</ref>


OR
*[[Hypokinesia|Hypokinetic]] or [[dyskinetic]] areas in the wall of the [[heart]]
 
*[[Myocardial]] [[edema]]
There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
*Apical [[thrombi]]


===Other Imaging Findings===
===Other Imaging Findings===
There are no other imaging findings associated with [disease name].
====Positron Emission Tomography (PET) Scan ====
 
In patients with stress cardiomyopathy, a [[PET scan]] may be done. Areas of [[hypokinesia]] or [[dyskinesia]] have reduced [[glucose]] utilization compared to normal regions.<ref name="pmid25071891">{{cite journal |vauthors=Testa M, Feola M |title=Usefulness of myocardial positron emission tomography/nuclear imaging in Takotsubo cardiomyopathy |journal=World J Radiol |volume=6 |issue=7 |pages=502–6 |year=2014 |pmid=25071891 |pmc=4109102 |doi=10.4329/wjr.v6.i7.502 |url=}}</ref>
OR
====Coronary Angiography ====


[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
* Stress cardiomyopathy can mimic an [[acute MI]], mainly [[anterior MI]], since the clinical presentation, [[ECG]] and laboratory findings are similar. Hence, [[coronary angiography]] is considered a great diagnostic modality to differentiate between the two diagnoses.
*A normal [[angiography]] or absence of substantial [[coronary]] [[stenosis]] supports the diagnosis of stress cardiomyopathy.<ref name="pmid191064007">{{cite journal |vauthors=Akashi YJ, Goldstein DS, Barbaro G, Ueyama T |title=Takotsubo cardiomyopathy: a new form of acute, reversible heart failure |journal=Circulation |volume=118 |issue=25 |pages=2754–62 |year=2008 |pmid=19106400 |pmc=4893309 |doi=10.1161/CIRCULATIONAHA.108.767012 |url=}}</ref><ref name="pmid152761003">{{cite journal |vauthors=Bybee KA, Prasad A, Barsness GW, Lerman A, Jaffe AS, Murphy JG, Wright RS, Rihal CS |title=Clinical characteristics and thrombolysis in myocardial infarction frame counts in women with transient left ventricular apical ballooning syndrome |journal=Am. J. Cardiol. |volume=94 |issue=3 |pages=343–6 |year=2004 |pmid=15276100 |doi=10.1016/j.amjcard.2004.04.030 |url=}}</ref><ref name="pmid280417127">{{cite journal |vauthors=Efferth T, Banerjee M, Paul NW |title=Broken heart, tako-tsubo or stress cardiomyopathy? Metaphors, meanings and their medical impact |journal=Int. J. Cardiol. |volume= |issue= |pages= |year=2016 |pmid=28041712 |doi=10.1016/j.ijcard.2016.12.129 |url=}}</ref>


===Other Diagnostic Studies===
===Other Diagnostic Studies===
There are no other diagnostic studies associated with [disease name].
====Cardiac Catheterization ====
When patients with stress cardiomyopathy undergo [[cardiac catheterization]], the following findings are usually reported:<ref name="pmid182065217">{{cite journal |vauthors=Brenner ZR, Powers J |title=Takotsubo cardiomyopathy |journal=Heart Lung |volume=37 |issue=1 |pages=1–7 |year=2008 |pmid=18206521 |doi=10.1016/j.hrtlng.2006.12.003 |url=}}</ref><ref name="pmid197267766">{{cite journal |vauthors=Tsai TT, Nallamothu BK, Prasad A, Saint S, Bates ER |title=Clinical problem-solving. A change of heart |journal=N. Engl. J. Med. |volume=361 |issue=10 |pages=1010–6 |year=2009 |pmid=19726776 |doi=10.1056/NEJMcps0903023 |url=}}</ref><ref name="pmid152761004">{{cite journal |vauthors=Bybee KA, Prasad A, Barsness GW, Lerman A, Jaffe AS, Murphy JG, Wright RS, Rihal CS |title=Clinical characteristics and thrombolysis in myocardial infarction frame counts in women with transient left ventricular apical ballooning syndrome |journal=Am. J. Cardiol. |volume=94 |issue=3 |pages=343–6 |year=2004 |pmid=15276100 |doi=10.1016/j.amjcard.2004.04.030 |url=}}</ref>


OR
*Normal [[anatomy]] of the [[coronary arteries]], without evidence of [[acute]] [[plaque rupture]]
*Low [[Ejection fraction|ejection fraction (EF)]]
*Minimal or no evidence of [[coronary vasospasm]]
*Minimal disturbance of [[microcirculation]]


[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
====Myocardial Biopsy ====


OR
*Myocardial biopsy, although not necessary for diagnosis, can distinguish between stress cardiomyopathy and [[MI]].
*The histological findings on myocardial biopsy in patients with stress cardiomyopathy include:<ref name="pmid191064008">{{cite journal |vauthors=Akashi YJ, Goldstein DS, Barbaro G, Ueyama T |title=Takotsubo cardiomyopathy: a new form of acute, reversible heart failure |journal=Circulation |volume=118 |issue=25 |pages=2754–62 |year=2008 |pmid=19106400 |pmc=4893309 |doi=10.1161/CIRCULATIONAHA.108.767012 |url=}}</ref><ref name="pmid182065217" />
**[[Inflammatory]] infiltrates, consisting of [[mononuclear lymphocytes]], [[leukocytes]] and [[macrophages]]
**[[Myocardial]] [[fibrosis]]
**Contraction bands, which may or may not be associated with [[necrosis]]


Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].
*The combination of inflammatory changes and contraction bands distinguish stress cardiomyopathy from [[coagulative necrosis]] seen in [[MI]].<ref name="pmid191064008" />


==Treatment==
==Treatment==

Revision as of 22:44, 17 July 2020

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List of terms related to COVID-19-associated stress cardiomyopathy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: José Eduardo Riceto Loyola Junior, M.D.[2]

Synonyms and keywords:

Overview

Historical Perspective

  • COVID-19-associated stress cardiomyopathy was first described by Elena Roca, an Italian physician, in April 2020.[1]

Classification

  • There is no established system for the classification of COVID-19-associated stress cardiomyopathy.

Pathophysiology

  • It is thought that COVID-19-associated stress cardiomyopathy is the result of extreme sympathetic stimulation due to abnormal release of catecholamines causing epicardial coronary vasospasm.
  • Many mechanisms occurring in COVID-19 patients may lead to myocardial injury and left ventricular dysfunction.[2]
  • One of the proposed theory is that patients may experience stress-induced adrenergic discharge as consequence of fever and inflammatory response to infection. One other factor to consider is the direct SARS-CoV-2 injury causing endothelial dysfunction, which may cause microvascular vasoconstriction that can manifest in a transient left ventricular apical dysfunction, (apical ballooning).[3]
  • Proposed mechanisms that have the potential to cause myocardial injury in acute coronavirus disease 2019 cardiovascular syndrome:[4]
 
 
 
 
 
 
 
 
 
 
 
 
 
Stress Induced Cardiomyopathy
 
 
 
 
 
 
 
 
 
 
 
Microvascular/Thrombotic Injury
 
 
 
 
 
 
 
 
Cytokine Storm
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pre-existing cardiovascular Disease
 
 
 
 
 
Acute Myocardial Injury Characterized by Abnormal Troponin
 
 
 
 
 
Viral Myocarditis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hypoxemia
 
 
 
 
 
 
 
 
Hypotension +/- Shock
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ventricular or Atrial Arrhythmias
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Causes

  • COVID-19-associated stress cardiomyopathy may be caused by a very intense sympathetic stimulation which is theorized to be caused either due to direct viral action or the ongoing psychological, economical and social effects (physical distancing rules, lack of social interaction) of the pandemic due to the imposed quarantine.[3]

Differentiating COVID-19-associated stress cardiomyopathy from other Diseases

  • COVID-19-associated stress cardiomyopathy must be differentiated from other diseases that cause left ventricular dysfunction such as acute myocardial infarction (STEMI and NSTEMI) and viral myocarditis.

Epidemiology and Demographics

  • The incidence of COVID-19-associated stress cardiomyopathy is approximately 7.8% of all patients presenting acute coronary syndrome.[3]
  • In comparison, the stress cardiomyopathy incidence in the pre-COVID-19 period was varying between 1.5-1.8%.[3]

Risk Factors

  • There are no established risk factors for COVID-19-associated stress cardiomyopathy.
  • Hypertension was, however, the most frequently comorbidity found across the groups in the COVID-19 period patients, as was hyperlipidemia.[3]

Screening

  • There is insufficient evidence to recommend routine screening for COVID-19-associated stress cardiomyopathy.

Natural History, Complications, and Prognosis

  • A study evaluated the outcomes for patients with stress cardiomyopathy. COVID-19-associated stress cardiomyopathy outcomes were similar to the stress cardiomyopathy not related to COVID-19 with regard to mortality and 30-day rehospitalization.[3]
  • The same study showed that COVID-19-associated stress cardiomyopathy patients had a significantly longer hospital length of stay. in comparison to the ones not related to COVID-19.[3]
  • Provided that patients survive the initial insult without any complications, most patients recover and have a normalized cardiac function within a few weeks.[5][6][7]

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Symptoms of stress cardiomyopathy can mimic acute coronary syndrome. The most common presenting symptoms are:[20][21][22][23][24][25]

When taking the history from a patient with suspected stress cardiomyopathy, it is important to ask about:[21][23]

Physical Examination

Organ System Findings Suggestive Of
General appearance Patient may be anxious, ill-appearing or diaphoretic
Vital signs Cardiogenic shock
Cardiac Murmurs, S3, gallop rhythm, displaced PMI Heart failure
Respiratory Rales, crackles Pulmonary edema

Laboratory Findings

  • Laboratory findings consistent with the diagnosis of COVID-19-associated stress cardiomyopathy include elevated troponin and Pro-BNP.[3]
  • Elevated levels of serum catecholamines may also be found in patients with stress cardiomyopathy.[37][38][39][40]

Electrocardiogram

The ECG findings are largely the same of the regular stress cardiomyopathy, and are often confused with those of an acute anterior wall myocardial infarction.[41][42] Findings on ECG include:[42][43][44][45][46][47][48]

X-ray

Takotsubo in Japanese language refer to a ceramic pot, which is used to trap octopus. The typical chest x-ray findings in patients with stress cardiomyopathy include a takotsubo-shaped heart, in which there is apical ballooning and narrowing of the proximal portion near the great vessels.

Echocardiography or Ultrasound

The following echocardiographic findings may be seen in patients with stress cardiomyopathy:[49][50][51][52]

CT scan

A cardiac CT scan can also help differentiate between stress cardiomyopathy and acute MI. Regional abnormalities in the wall motion of the heart, along with absence of coronary atherosclerosis support the diagnosis of stress cardiomyopathy over an acute MI.[12]

MRI

Other findings on CMR include:[64][65]

Other Imaging Findings

Positron Emission Tomography (PET) Scan

In patients with stress cardiomyopathy, a PET scan may be done. Areas of hypokinesia or dyskinesia have reduced glucose utilization compared to normal regions.[66]

Coronary Angiography

Other Diagnostic Studies

Cardiac Catheterization

When patients with stress cardiomyopathy undergo cardiac catheterization, the following findings are usually reported:[70][71][72]

Myocardial Biopsy

  • The combination of inflammatory changes and contraction bands distinguish stress cardiomyopathy from coagulative necrosis seen in MI.[73]

Treatment

Medical Therapy

  • There is no treatment for specific treatment for stress cardiomyopathy when associated with COVID-19. The mainstay of therapy is supportive care, which is the same for the stress cardiomyopathy not related to COVID-19..
  • Medical therapy in patients with stress cardiomyopathy is mostly targeted towards the treatment of complications. For stress cardiomyopathy per se, the use of heparin and aspirin are controversial. It must be noted that the use of beta blockers alone is not advised, as this will result unopposed activity of catecholamines at the alpha receptors and can cause further prolongation of the QT interval. The combined use of alpha- and beta blockers is reasonable.[74]

Treatment of Complications

The following interventions are performed if their associated complications arise:[74][75][76]

Surgery

  • Surgical intervention is not recommended for the management of COVID-19-associated stress cardiomyopathy.

Primary Prevention

  • There are no established measures for the primary prevention of COVID-19-associated stress cardiomyopathy if a patient has acquired COVID-19 infection.
  • Preventive measures should be taken to avoid COVID-19 infection.

Secondary Prevention

  • There are no established measures for the secondary prevention of COVID-19-associated stress cardiomyopathy.

References

  1. ↑ Roca E, Lombardi C, Campana M, Vivaldi O, Bigni B, Bertozzi B; et al. (2020). "Takotsubo Syndrome Associated with COVID-19". Eur J Case Rep Intern Med. 7 (5): 001665. doi:10.12890/2020_001665. PMC 7213829 Check |pmc= value (help). PMID 32399453 Check |pmid= value (help).
  2. ↑ Pasqualetto MC, Secco E, Nizzetto M, Scevola M, Altafini L, Cester A; et al. (2020). "Stress Cardiomyopathy in COVID-19 Disease". Eur J Case Rep Intern Med. 7 (6): 001718. doi:10.12890/2020_001718. PMC 7279910 Check |pmc= value (help). PMID 32523926 Check |pmid= value (help).
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 Jabri A, Kalra A, Kumar A, Alameh A, Adroja S, Bashir H; et al. (2020). "Incidence of Stress Cardiomyopathy During the Coronavirus Disease 2019 Pandemic". JAMA Netw Open. 3 (7): e2014780. doi:10.1001/jamanetworkopen.2020.14780. PMC 7348683 Check |pmc= value (help). PMID 32644140 Check |pmid= value (help).
  4. ↑ Hendren NS, Drazner MH, Bozkurt B, Cooper LT (2020). "Description and Proposed Management of the Acute COVID-19 Cardiovascular Syndrome". Circulation. 141 (23): 1903–1914. doi:10.1161/CIRCULATIONAHA.120.047349. PMC 7314493 Check |pmc= value (help). PMID 32297796 Check |pmid= value (help).
  5. ↑ Akashi YJ, Goldstein DS, Barbaro G, Ueyama T (2008). "Takotsubo cardiomyopathy: a new form of acute, reversible heart failure". Circulation. 118 (25): 2754–62. doi:10.1161/CIRCULATIONAHA.108.767012. PMC 4893309. PMID 19106400.
  6. ↑ Prasad A, Lerman A, Rihal CS (2008). "Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction". Am. Heart J. 155 (3): 408–17. doi:10.1016/j.ahj.2007.11.008. PMID 18294473.
  7. ↑ Tsai TT, Nallamothu BK, Prasad A, Saint S, Bates ER (2009). "Clinical problem-solving. A change of heart". N. Engl. J. Med. 361 (10): 1010–6. doi:10.1056/NEJMcps0903023. PMID 19726776.
  8. ↑ Akashi YJ, Goldstein DS, Barbaro G, Ueyama T (2008). "Takotsubo cardiomyopathy: a new form of acute, reversible heart failure". Circulation. 118 (25): 2754–62. doi:10.1161/CIRCULATIONAHA.108.767012. PMC 4893309. PMID 19106400.
  9. ↑ Omerovic E (2011). "How to think about stress-induced cardiomyopathy?--Think "out of the box"!". Scand. Cardiovasc. J. 45 (2): 67–71. doi:10.3109/14017431.2011.565794. PMID 21401402.
  10. ↑ Brenner ZR, Powers J (2008). "Takotsubo cardiomyopathy". Heart Lung. 37 (1): 1–7. doi:10.1016/j.hrtlng.2006.12.003. PMID 18206521.
  11. ↑ Tsai TT, Nallamothu BK, Prasad A, Saint S, Bates ER (2009). "Clinical problem-solving. A change of heart". N. Engl. J. Med. 361 (10): 1010–6. doi:10.1056/NEJMcps0903023. PMID 19726776.
  12. ↑ 12.0 12.1 Efferth T, Banerjee M, Paul NW (2016). "Broken heart, tako-tsubo or stress cardiomyopathy? Metaphors, meanings and their medical impact". Int. J. Cardiol. doi:10.1016/j.ijcard.2016.12.129. PMID 28041712.
  13. ↑ Bybee KA, Kara T, Prasad A, Lerman A, Barsness GW, Wright RS, Rihal CS (2004). "Systematic review: transient left ventricular apical ballooning: a syndrome that mimics ST-segment elevation myocardial infarction". Ann. Intern. Med. 141 (11): 858–65. PMID 15583228.
  14. ↑ Tsuchihashi K, Ueshima K, Uchida T, Oh-mura N, Kimura K, Owa M, Yoshiyama M, Miyazaki S, Haze K, Ogawa H, Honda T, Hase M, Kai R, Morii I (2001). "Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction. Angina Pectoris-Myocardial Infarction Investigations in Japan". J. Am. Coll. Cardiol. 38 (1): 11–8. PMID 11451258.
  15. ↑ Sharkey SW, Lesser JR, Zenovich AG, Maron MS, Lindberg J, Longe TF, Maron BJ (2005). "Acute and reversible cardiomyopathy provoked by stress in women from the United States". Circulation. 111 (4): 472–9. doi:10.1161/01.CIR.0000153801.51470.EB. PMID 15687136.
  16. ↑ Desmet WJ, Adriaenssens BF, Dens JA (2003). "Apical ballooning of the left ventricle: first series in white patients". Heart. 89 (9): 1027–31. PMC 1767823. PMID 12923018.
  17. ↑ Krishnamoorthy P, Garg J, Sharma A, Palaniswamy C, Shah N, Lanier G, Patel NC, Lavie CJ, Ahmad H (2015). "Gender Differences and Predictors of Mortality in Takotsubo Cardiomyopathy: Analysis from the National Inpatient Sample 2009-2010 Database". Cardiology. 132 (2): 131–136. doi:10.1159/000430782. PMID 26159108.
  18. ↑ Prasad A, Lerman A, Rihal CS (2008). "Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction". Am. Heart J. 155 (3): 408–17. doi:10.1016/j.ahj.2007.11.008. PMID 18294473.
  19. ↑ Akashi YJ, Goldstein DS, Barbaro G, Ueyama T (2008). "Takotsubo cardiomyopathy: a new form of acute, reversible heart failure". Circulation. 118 (25): 2754–62. doi:10.1161/CIRCULATIONAHA.108.767012. PMC 4893309. PMID 19106400.
  20. ↑ Akashi YJ, Goldstein DS, Barbaro G, Ueyama T (2008). "Takotsubo cardiomyopathy: a new form of acute, reversible heart failure". Circulation. 118 (25): 2754–62. doi:10.1161/CIRCULATIONAHA.108.767012. PMC 4893309. PMID 19106400.
  21. ↑ 21.0 21.1 Brenner ZR, Powers J (2008). "Takotsubo cardiomyopathy". Heart Lung. 37 (1): 1–7. doi:10.1016/j.hrtlng.2006.12.003. PMID 18206521.
  22. ↑ Prasad A, Lerman A, Rihal CS (2008). "Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction". Am. Heart J. 155 (3): 408–17. doi:10.1016/j.ahj.2007.11.008. PMID 18294473.
  23. ↑ 23.0 23.1 Bybee KA, Prasad A, Barsness GW, Lerman A, Jaffe AS, Murphy JG, Wright RS, Rihal CS (2004). "Clinical characteristics and thrombolysis in myocardial infarction frame counts in women with transient left ventricular apical ballooning syndrome". Am. J. Cardiol. 94 (3): 343–6. doi:10.1016/j.amjcard.2004.04.030. PMID 15276100.
  24. ↑ Templin C, Ghadri JR, Diekmann J, Napp LC, Bataiosu DR, Jaguszewski M, Cammann VL, Sarcon A, Geyer V, Neumann CA, Seifert B, Hellermann J, Schwyzer M, Eisenhardt K, Jenewein J, Franke J, Katus HA, Burgdorf C, Schunkert H, Moeller C, Thiele H, Bauersachs J, Tschöpe C, Schultheiss HP, Laney CA, Rajan L, Michels G, Pfister R, Ukena C, Böhm M, Erbel R, Cuneo A, Kuck KH, Jacobshagen C, Hasenfuss G, Karakas M, Koenig W, Rottbauer W, Said SM, Braun-Dullaeus RC, Cuculi F, Banning A, Fischer TA, Vasankari T, Airaksinen KE, Fijalkowski M, Rynkiewicz A, Pawlak M, Opolski G, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Crea F, Dichtl W, Franz WM, Empen K, Felix SB, Delmas C, Lairez O, Erne P, Bax JJ, Ford I, Ruschitzka F, Prasad A, Lüscher TF (2015). "Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy". N. Engl. J. Med. 373 (10): 929–38. doi:10.1056/NEJMoa1406761. PMID 26332547.
  25. ↑ Efferth T, Banerjee M, Paul NW (2016). "Broken heart, tako-tsubo or stress cardiomyopathy? Metaphors, meanings and their medical impact". Int. J. Cardiol. doi:10.1016/j.ijcard.2016.12.129. PMID 28041712.
  26. ↑ Y-Hassan S, Yamasaki K (2013). "History of takotsubo syndrome: is the syndrome really described as a disease entity first in 1990? Some inaccuracies". Int. J. Cardiol. 166 (3): 736–7. doi:10.1016/j.ijcard.2012.09.183. PMID 23073280.
  27. ↑ Akashi YJ, Goldstein DS, Barbaro G, Ueyama T (2008). "Takotsubo cardiomyopathy: a new form of acute, reversible heart failure". Circulation. 118 (25): 2754–62. doi:10.1161/CIRCULATIONAHA.108.767012. PMC 4893309. PMID 19106400.
  28. ↑ Omerovic E (2011). "How to think about stress-induced cardiomyopathy?--Think "out of the box"!". Scand. Cardiovasc. J. 45 (2): 67–71. doi:10.3109/14017431.2011.565794. PMID 21401402.
  29. ↑ Brenner ZR, Powers J (2008). "Takotsubo cardiomyopathy". Heart Lung. 37 (1): 1–7. doi:10.1016/j.hrtlng.2006.12.003. PMID 18206521.
  30. ↑ Tsai TT, Nallamothu BK, Prasad A, Saint S, Bates ER (2009). "Clinical problem-solving. A change of heart". N. Engl. J. Med. 361 (10): 1010–6. doi:10.1056/NEJMcps0903023. PMID 19726776.
  31. ↑ Efferth T, Banerjee M, Paul NW (2016). "Broken heart, tako-tsubo or stress cardiomyopathy? Metaphors, meanings and their medical impact". Int. J. Cardiol. doi:10.1016/j.ijcard.2016.12.129. PMID 28041712.
  32. ↑ Bybee KA, Kara T, Prasad A, Lerman A, Barsness GW, Wright RS, Rihal CS (2004). "Systematic review: transient left ventricular apical ballooning: a syndrome that mimics ST-segment elevation myocardial infarction". Ann. Intern. Med. 141 (11): 858–65. PMID 15583228.
  33. ↑ Tsuchihashi K, Ueshima K, Uchida T, Oh-mura N, Kimura K, Owa M, Yoshiyama M, Miyazaki S, Haze K, Ogawa H, Honda T, Hase M, Kai R, Morii I (2001). "Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction. Angina Pectoris-Myocardial Infarction Investigations in Japan". J. Am. Coll. Cardiol. 38 (1): 11–8. PMID 11451258.
  34. ↑ Sharkey SW, Lesser JR, Zenovich AG, Maron MS, Lindberg J, Longe TF, Maron BJ (2005). "Acute and reversible cardiomyopathy provoked by stress in women from the United States". Circulation. 111 (4): 472–9. doi:10.1161/01.CIR.0000153801.51470.EB. PMID 15687136.
  35. ↑ Desmet WJ, Adriaenssens BF, Dens JA (2003). "Apical ballooning of the left ventricle: first series in white patients". Heart. 89 (9): 1027–31. PMC 1767823. PMID 12923018.
  36. ↑ Krishnamoorthy P, Garg J, Sharma A, Palaniswamy C, Shah N, Lanier G, Patel NC, Lavie CJ, Ahmad H (2015). "Gender Differences and Predictors of Mortality in Takotsubo Cardiomyopathy: Analysis from the National Inpatient Sample 2009-2010 Database". Cardiology. 132 (2): 131–136. doi:10.1159/000430782. PMID 26159108.
  37. ↑ Akashi YJ, Goldstein DS, Barbaro G, Ueyama T (2008). "Takotsubo cardiomyopathy: a new form of acute, reversible heart failure". Circulation. 118 (25): 2754–62. doi:10.1161/CIRCULATIONAHA.108.767012. PMC 4893309. PMID 19106400.
  38. ↑ Brenner ZR, Powers J (2008). "Takotsubo cardiomyopathy". Heart Lung. 37 (1): 1–7. doi:10.1016/j.hrtlng.2006.12.003. PMID 18206521.
  39. ↑ Bybee KA, Prasad A, Barsness GW, Lerman A, Jaffe AS, Murphy JG, Wright RS, Rihal CS (2004). "Clinical characteristics and thrombolysis in myocardial infarction frame counts in women with transient left ventricular apical ballooning syndrome". Am. J. Cardiol. 94 (3): 343–6. doi:10.1016/j.amjcard.2004.04.030. PMID 15276100.
  40. ↑ Efferth T, Banerjee M, Paul NW (2016). "Broken heart, tako-tsubo or stress cardiomyopathy? Metaphors, meanings and their medical impact". Int. J. Cardiol. doi:10.1016/j.ijcard.2016.12.129. PMID 28041712.
  41. ↑ Bybee KA, Motiei A, Syed IS, Kara T, Prasad A, Lennon RJ, Murphy JG, Hammill SC, Rihal CS, Wright RS (2006). "Electrocardiography cannot reliably differentiate transient left ventricular apical ballooning syndrome from anterior ST-segment elevation myocardial infarction". J Electrocardiol. PMID 17067626.
  42. ↑ 42.0 42.1 Akashi YJ, Goldstein DS, Barbaro G, Ueyama T (2008). "Takotsubo cardiomyopathy: a new form of acute, reversible heart failure". Circulation. 118 (25): 2754–62. doi:10.1161/CIRCULATIONAHA.108.767012. PMC 4893309. PMID 19106400.
  43. ↑ Brenner ZR, Powers J (2008). "Takotsubo cardiomyopathy". Heart Lung. 37 (1): 1–7. doi:10.1016/j.hrtlng.2006.12.003. PMID 18206521.
  44. ↑ Prasad A, Lerman A, Rihal CS (2008). "Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction". Am. Heart J. 155 (3): 408–17. doi:10.1016/j.ahj.2007.11.008. PMID 18294473.
  45. ↑ Tsai TT, Nallamothu BK, Prasad A, Saint S, Bates ER (2009). "Clinical problem-solving. A change of heart". N. Engl. J. Med. 361 (10): 1010–6. doi:10.1056/NEJMcps0903023. PMID 19726776.
  46. ↑ Bybee KA, Prasad A, Barsness GW, Lerman A, Jaffe AS, Murphy JG, Wright RS, Rihal CS (2004). "Clinical characteristics and thrombolysis in myocardial infarction frame counts in women with transient left ventricular apical ballooning syndrome". Am. J. Cardiol. 94 (3): 343–6. doi:10.1016/j.amjcard.2004.04.030. PMID 15276100.
  47. ↑ Templin C, Ghadri JR, Diekmann J, Napp LC, Bataiosu DR, Jaguszewski M, Cammann VL, Sarcon A, Geyer V, Neumann CA, Seifert B, Hellermann J, Schwyzer M, Eisenhardt K, Jenewein J, Franke J, Katus HA, Burgdorf C, Schunkert H, Moeller C, Thiele H, Bauersachs J, Tschöpe C, Schultheiss HP, Laney CA, Rajan L, Michels G, Pfister R, Ukena C, Böhm M, Erbel R, Cuneo A, Kuck KH, Jacobshagen C, Hasenfuss G, Karakas M, Koenig W, Rottbauer W, Said SM, Braun-Dullaeus RC, Cuculi F, Banning A, Fischer TA, Vasankari T, Airaksinen KE, Fijalkowski M, Rynkiewicz A, Pawlak M, Opolski G, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Crea F, Dichtl W, Franz WM, Empen K, Felix SB, Delmas C, Lairez O, Erne P, Bax JJ, Ford I, Ruschitzka F, Prasad A, Lüscher TF (2015). "Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy". N. Engl. J. Med. 373 (10): 929–38. doi:10.1056/NEJMoa1406761. PMID 26332547.
  48. ↑ Efferth T, Banerjee M, Paul NW (2016). "Broken heart, tako-tsubo or stress cardiomyopathy? Metaphors, meanings and their medical impact". Int. J. Cardiol. doi:10.1016/j.ijcard.2016.12.129. PMID 28041712.
  49. ↑ Brenner ZR, Powers J (2008). "Takotsubo cardiomyopathy". Heart Lung. 37 (1): 1–7. doi:10.1016/j.hrtlng.2006.12.003. PMID 18206521.
  50. ↑ Prasad A, Lerman A, Rihal CS (2008). "Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction". Am. Heart J. 155 (3): 408–17. doi:10.1016/j.ahj.2007.11.008. PMID 18294473.
  51. ↑ Tsai TT, Nallamothu BK, Prasad A, Saint S, Bates ER (2009). "Clinical problem-solving. A change of heart". N. Engl. J. Med. 361 (10): 1010–6. doi:10.1056/NEJMcps0903023. PMID 19726776.
  52. ↑ Efferth T, Banerjee M, Paul NW (2016). "Broken heart, tako-tsubo or stress cardiomyopathy? Metaphors, meanings and their medical impact". Int. J. Cardiol. doi:10.1016/j.ijcard.2016.12.129. PMID 28041712.
  53. ↑ Prasad A, Lerman A, Rihal CS (2008). "Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction". Am. Heart J. 155 (3): 408–17. doi:10.1016/j.ahj.2007.11.008. PMID 18294473.
  54. ↑ Sharkey SW, Lesser JR, Zenovich AG, Maron MS, Lindberg J, Longe TF, Maron BJ (2005). "Acute and reversible cardiomyopathy provoked by stress in women from the United States". Circulation. 111 (4): 472–9. doi:10.1161/01.CIR.0000153801.51470.EB. PMID 15687136.
  55. ↑ Haghi D, Fluechter S, Suselbeck T, Kaden JJ, Borggrefe M, Papavassiliu T (2007). "Cardiovascular magnetic resonance findings in typical versus atypical forms of the acute apical ballooning syndrome (Takotsubo cardiomyopathy)". Int. J. Cardiol. 120 (2): 205–11. doi:10.1016/j.ijcard.2006.09.019. PMID 17175045.
  56. ↑ 56.0 56.1 Mitchell JH, Hadden TB, Wilson JM, Achari A, Muthupillai R, Flamm SD (2007). "Clinical features and usefulness of cardiac magnetic resonance imaging in assessing myocardial viability and prognosis in Takotsubo cardiomyopathy (transient left ventricular apical ballooning syndrome)". Am. J. Cardiol. 100 (2): 296–301. doi:10.1016/j.amjcard.2007.02.091. PMID 17631086.
  57. ↑ Deetjen AG, Conradi G, Mollmann S, Rad A, Hamm CW, Dill T (2006). "Value of gadolinium-enhanced magnetic resonance imaging in patients with Tako-Tsubo-like left ventricular dysfunction". J Cardiovasc Magn Reson. 8 (2): 367–72. PMID 16669180.
  58. ↑ Abe Y, Kondo M, Matsuoka R, Araki M, Dohyama K, Tanio H (2003). "Assessment of clinical features in transient left ventricular apical ballooning". J. Am. Coll. Cardiol. 41 (5): 737–42. PMID 12628715.
  59. ↑ Dec GW (2005). "Recognition of the apical ballooning syndrome in the United States". Circulation. 111 (4): 388–90. doi:10.1161/01.CIR.0000155234.69439.E4. PMID 15687123.
  60. ↑ Handy AD, Prasad A, Olson TM (2009). "Investigating genetic variation of adrenergic receptors in familial stress cardiomyopathy (apical ballooning syndrome)". J Cardiol. 54 (3): 516–7. doi:10.1016/j.jjcc.2009.08.008. PMID 19944334.
  61. ↑ Sharkey SW, Maron BJ, Nelson P, Parpart M, Maron MS, Bristow MR (2009). "Adrenergic receptor polymorphisms in patients with stress (tako-tsubo) cardiomyopathy". J Cardiol. 53 (1): 53–7. doi:10.1016/j.jjcc.2008.08.006. PMID 19167638.
  62. ↑ Eitel I, von Knobelsdorff-Brenkenhoff F, Bernhardt P, Carbone I, Muellerleile K, Aldrovandi A, Francone M, Desch S, Gutberlet M, Strohm O, Schuler G, Schulz-Menger J, Thiele H, Friedrich MG (2011). "Clinical characteristics and cardiovascular magnetic resonance findings in stress (takotsubo) cardiomyopathy". JAMA. 306 (3): 277–86. doi:10.1001/jama.2011.992. PMID 21771988.
  63. ↑ Eitel I, Behrendt F, Schindler K, Kivelitz D, Gutberlet M, Schuler G, Thiele H (2008). "Differential diagnosis of suspected apical ballooning syndrome using contrast-enhanced magnetic resonance imaging". Eur. Heart J. 29 (21): 2651–9. doi:10.1093/eurheartj/ehn433. PMID 18820322.
  64. ↑ Efferth T, Banerjee M, Paul NW (2016). "Broken heart, tako-tsubo or stress cardiomyopathy? Metaphors, meanings and their medical impact". Int. J. Cardiol. doi:10.1016/j.ijcard.2016.12.129. PMID 28041712.
  65. ↑ Sharkey SW, Windenburg DC, Lesser JR, Maron MS, Hauser RG, Lesser JN, Haas TS, Hodges JS, Maron BJ (2010). "Natural history and expansive clinical profile of stress (tako-tsubo) cardiomyopathy". J. Am. Coll. Cardiol. 55 (4): 333–41. doi:10.1016/j.jacc.2009.08.057. PMID 20117439.
  66. ↑ Testa M, Feola M (2014). "Usefulness of myocardial positron emission tomography/nuclear imaging in Takotsubo cardiomyopathy". World J Radiol. 6 (7): 502–6. doi:10.4329/wjr.v6.i7.502. PMC 4109102. PMID 25071891.
  67. ↑ Akashi YJ, Goldstein DS, Barbaro G, Ueyama T (2008). "Takotsubo cardiomyopathy: a new form of acute, reversible heart failure". Circulation. 118 (25): 2754–62. doi:10.1161/CIRCULATIONAHA.108.767012. PMC 4893309. PMID 19106400.
  68. ↑ Bybee KA, Prasad A, Barsness GW, Lerman A, Jaffe AS, Murphy JG, Wright RS, Rihal CS (2004). "Clinical characteristics and thrombolysis in myocardial infarction frame counts in women with transient left ventricular apical ballooning syndrome". Am. J. Cardiol. 94 (3): 343–6. doi:10.1016/j.amjcard.2004.04.030. PMID 15276100.
  69. ↑ Efferth T, Banerjee M, Paul NW (2016). "Broken heart, tako-tsubo or stress cardiomyopathy? Metaphors, meanings and their medical impact". Int. J. Cardiol. doi:10.1016/j.ijcard.2016.12.129. PMID 28041712.
  70. ↑ 70.0 70.1 Brenner ZR, Powers J (2008). "Takotsubo cardiomyopathy". Heart Lung. 37 (1): 1–7. doi:10.1016/j.hrtlng.2006.12.003. PMID 18206521.
  71. ↑ Tsai TT, Nallamothu BK, Prasad A, Saint S, Bates ER (2009). "Clinical problem-solving. A change of heart". N. Engl. J. Med. 361 (10): 1010–6. doi:10.1056/NEJMcps0903023. PMID 19726776.
  72. ↑ Bybee KA, Prasad A, Barsness GW, Lerman A, Jaffe AS, Murphy JG, Wright RS, Rihal CS (2004). "Clinical characteristics and thrombolysis in myocardial infarction frame counts in women with transient left ventricular apical ballooning syndrome". Am. J. Cardiol. 94 (3): 343–6. doi:10.1016/j.amjcard.2004.04.030. PMID 15276100.
  73. ↑ 73.0 73.1 Akashi YJ, Goldstein DS, Barbaro G, Ueyama T (2008). "Takotsubo cardiomyopathy: a new form of acute, reversible heart failure". Circulation. 118 (25): 2754–62. doi:10.1161/CIRCULATIONAHA.108.767012. PMC 4893309. PMID 19106400.
  74. ↑ 74.0 74.1 Omerovic E (2011). "How to think about stress-induced cardiomyopathy?--Think "out of the box"!". Scand. Cardiovasc. J. 45 (2): 67–71. doi:10.3109/14017431.2011.565794. PMID 21401402.
  75. ↑ Brenner ZR, Powers J (2008). "Takotsubo cardiomyopathy". Heart Lung. 37 (1): 1–7. doi:10.1016/j.hrtlng.2006.12.003. PMID 18206521.
  76. ↑ Bybee KA, Kara T, Prasad A, Lerman A, Barsness GW, Wright RS, Rihal CS (2004). "Systematic review: transient left ventricular apical ballooning: a syndrome that mimics ST-segment elevation myocardial infarction". Ann. Intern. Med. 141 (11): 858–65.


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