An 82-year-old man, with a history of hypertension, diabetes mellitus, dyslipidemia, peripheral artery disease, and chronic renal failure but no prior history of heart disease attended the emergency room of a regional hospital with anginal chest pain consistent with heart failure. The electrocardiogram showed a 1mm ST segment elevation in leads V2-V3 and DI-AVL (figure 1A), and so the infarction protocol was activated. The patient reached the electrophysiology laboratory in Killip class II and a rapid polymerase chain reaction (PCR) test for acute respiratory severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was performed as part of the protocol. Coronary angiography showed coronary arteries free of lesions and cardiac ventriculography was performed. This showed a very reduced left ventricular ejection fraction with extensive apical akinesia (figure 1C,D). The PCR result was positive, indicating tako-tsubo syndrome related to viral infection.
The findings of ventriculography were confirmed by echocardiography, and chest x-ray showed signs of mild heart failure, with no evidence of pneumonia (figure 1B). The patient's progression was favorable; heart failure improved and he did not develop lung involvement secondary to the COVID-19 disease. Ten days after admission, he was discharged with only ongoing neurohormonal treatment.
The mechanism by which SARS-Cov-2 infection may cause tako-tsubo syndrome is not clear. However, viral infection has been associated with a state of systemic inflammation and this may be the trigger for the syndrome.
CONFLICTS OF INTERESTJ.A. Gómez-Hospital declares a consultant role for Abbott, Medtronic, Boston, Terumo, IHT. The remaining authors do not declare any conflicts of interest.