Apical Takotsubo Cardiomyopathy in a COVID-19 Patient Presenting with Stroke: A Case Report and Pathophysiologic Insights

Pramod Theetha Kariyanna¹, Harshith Priyan Chandrakumar¹, Apoorva Jayarangaiah², Abdullah Khan³, Volodymyr Vulkanov⁴, Michael Ashamalla¹, Moro O. Salifu¹ and Samy I. McFarlane^1,

¹Department of Internal Medicine, State University of New York- Downstate Medical Center, Brooklyn, New York, U.S.A-11203

²Division of Hematology and Oncology, Department of Internal Medicine, Albert Einstein College of medicine/Jacobi Medical Center, Bronx, N.Y., U.S.A 10461

³Divisions of Cardiology, Department of Internal Medicine, Brookdale University Hospital and Research Center, Brooklyn, New York, U.S.A-11212

⁴Neurology, Department of Internal Medicine, Brookdale University Hospital and Research Canter, Brooklyn, New York, U.S.A-11212

Cite this paper

Pramod Theetha Kariyanna, Harshith Priyan Chandrakumar, Apoorva Jayarangaiah, Abdullah Khan, Volodymyr Vulkanov, Michael Ashamalla, Moro O. Salifu and Samy I. McFarlane. Apical Takotsubo Cardiomyopathy in a COVID-19 Patient Presenting with Stroke: A Case Report and Pathophysiologic Insights. American Journal of Medical Case Reports. 2020; 8(10):350-357. doi: 10.12691/AJMCR-8-10-8

Abstract

COVID-19 is a pandemic that started in Wuhan city, Hubei province in China in December 2019 and is associated with high morbidity and mortality. It is characterized by a heightened inflammatory and prothrombotic state that are known to cause various cardiovascular manifestations such as thromboembolism, acute coronary syndrome and stroke. We here present a 72-year-old woman with multiple cardiovascular risk factors and COVI 19 pneumonia who presented with acute ischemic stroke. She was also noted to have ST segment elevation myocardial infarction (STEMI) on the electrocardiogram however the imaging and clinical presentation was consistent with apical takotsubo cardiomyopathy. We here discuss the various pathophysiologic mechanisms by which COVID-19 can result in acute stroke. The patient likely developed takotsubo cardiomyopathy because of stroke and acute COVID-19 induced sympathetic stimulation and catecholamine surge. To the best of our knowledge this is the first case of apical variant of takotsubo cardiomyopathy in a COVID-19 report.

Keywords

COVID-19, takotsubo cardiomyopathy, stress cardiomyopathy, STEMI, stroke, cerebrovascular accident

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

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