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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Typical takotsubo syndrome triggered by SARS-CoV-2 infection</title>
<author><name sortKey="Meyer, Philippe" sort="Meyer, Philippe" uniqKey="Meyer P" first="Philippe" last="Meyer">Philippe Meyer</name>
<affiliation><nlm:aff id="ehaa306-aff1"><institution>Cardiology Service, Geneva University Hospitals</institution>
, Geneva, Switzerland</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Degrauwe, Sophie" sort="Degrauwe, Sophie" uniqKey="Degrauwe S" first="Sophie" last="Degrauwe">Sophie Degrauwe</name>
<affiliation><nlm:aff id="ehaa306-aff1"><institution>Cardiology Service, Geneva University Hospitals</institution>
, Geneva, Switzerland</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Delden, Christian Van" sort="Delden, Christian Van" uniqKey="Delden C" first="Christian Van" last="Delden">Christian Van Delden</name>
<affiliation><nlm:aff id="ehaa306-aff2"><institution>Infectious diseases Service, Geneva University Hospitals</institution>
, Geneva, Switzerland</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Ghadri, Jelena Rima" sort="Ghadri, Jelena Rima" uniqKey="Ghadri J" first="Jelena-Rima" last="Ghadri">Jelena-Rima Ghadri</name>
<affiliation><nlm:aff id="ehaa306-aff3"><institution>Department of Cardiology, University Hospital of Zurich</institution>
, Zurich, Switzerland</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Templin, Christian" sort="Templin, Christian" uniqKey="Templin C" first="Christian" last="Templin">Christian Templin</name>
<affiliation><nlm:aff id="ehaa306-aff3"><institution>Department of Cardiology, University Hospital of Zurich</institution>
, Zurich, Switzerland</nlm:aff>
</affiliation>
</author>
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<idno type="pmc">7184501</idno>
<idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7184501</idno>
<idno type="RBID">PMC:7184501</idno>
<idno type="doi">10.1093/eurheartj/ehaa306</idno>
<date when="2020">2020</date>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Typical takotsubo syndrome triggered by SARS-CoV-2 infection</title>
<author><name sortKey="Meyer, Philippe" sort="Meyer, Philippe" uniqKey="Meyer P" first="Philippe" last="Meyer">Philippe Meyer</name>
<affiliation><nlm:aff id="ehaa306-aff1"><institution>Cardiology Service, Geneva University Hospitals</institution>
, Geneva, Switzerland</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Degrauwe, Sophie" sort="Degrauwe, Sophie" uniqKey="Degrauwe S" first="Sophie" last="Degrauwe">Sophie Degrauwe</name>
<affiliation><nlm:aff id="ehaa306-aff1"><institution>Cardiology Service, Geneva University Hospitals</institution>
, Geneva, Switzerland</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Delden, Christian Van" sort="Delden, Christian Van" uniqKey="Delden C" first="Christian Van" last="Delden">Christian Van Delden</name>
<affiliation><nlm:aff id="ehaa306-aff2"><institution>Infectious diseases Service, Geneva University Hospitals</institution>
, Geneva, Switzerland</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Ghadri, Jelena Rima" sort="Ghadri, Jelena Rima" uniqKey="Ghadri J" first="Jelena-Rima" last="Ghadri">Jelena-Rima Ghadri</name>
<affiliation><nlm:aff id="ehaa306-aff3"><institution>Department of Cardiology, University Hospital of Zurich</institution>
, Zurich, Switzerland</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Templin, Christian" sort="Templin, Christian" uniqKey="Templin C" first="Christian" last="Templin">Christian Templin</name>
<affiliation><nlm:aff id="ehaa306-aff3"><institution>Department of Cardiology, University Hospital of Zurich</institution>
, Zurich, Switzerland</nlm:aff>
</affiliation>
</author>
</analytic>
<series><title level="j">European Heart Journal</title>
<idno type="ISSN">0195-668X</idno>
<idno type="eISSN">1522-9645</idno>
<imprint><date when="2020">2020</date>
</imprint>
</series>
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<pmc article-type="case-report"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Eur Heart J</journal-id>
<journal-id journal-id-type="iso-abbrev">Eur. Heart J</journal-id>
<journal-id journal-id-type="publisher-id">eurheartj</journal-id>
<journal-title-group><journal-title>European Heart Journal</journal-title>
</journal-title-group>
<issn pub-type="ppub">0195-668X</issn>
<issn pub-type="epub">1522-9645</issn>
<publisher><publisher-name>Oxford University Press</publisher-name>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">32285915</article-id>
<article-id pub-id-type="pmc">7184501</article-id>
<article-id pub-id-type="doi">10.1093/eurheartj/ehaa306</article-id>
<article-id pub-id-type="publisher-id">ehaa306</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Cardiovascular Flashlight</subject>
</subj-group>
</article-categories>
<title-group><article-title>Typical takotsubo syndrome triggered by SARS-CoV-2 infection</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0002-2430-8953</contrib-id>
<name><surname>Meyer</surname>
<given-names>Philippe</given-names>
</name>
<xref ref-type="corresp" rid="ehaa306-cor1"></xref>
<xref ref-type="aff" rid="ehaa306-aff1">e1</xref>
<pmc-comment>philippe.meyer@hcuge.ch </pmc-comment>
</contrib>
<contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0002-2484-0835</contrib-id>
<name><surname>Degrauwe</surname>
<given-names>Sophie</given-names>
</name>
<xref ref-type="aff" rid="ehaa306-aff1">e1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Delden</surname>
<given-names>Christian Van</given-names>
</name>
<xref ref-type="aff" rid="ehaa306-aff2">e2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Ghadri</surname>
<given-names>Jelena-Rima</given-names>
</name>
<xref ref-type="aff" rid="ehaa306-aff3">e3</xref>
</contrib>
<contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0003-0287-4193</contrib-id>
<name><surname>Templin</surname>
<given-names>Christian</given-names>
</name>
<xref ref-type="aff" rid="ehaa306-aff3">e3</xref>
</contrib>
</contrib-group>
<aff id="ehaa306-aff1"><label>e1</label>
<institution>Cardiology Service, Geneva University Hospitals</institution>
, Geneva, Switzerland</aff>
<aff id="ehaa306-aff2"><label>e2</label>
<institution>Infectious diseases Service, Geneva University Hospitals</institution>
, Geneva, Switzerland</aff>
<aff id="ehaa306-aff3"><label>e3</label>
<institution>Department of Cardiology, University Hospital of Zurich</institution>
, Zurich, Switzerland</aff>
<author-notes><corresp id="ehaa306-cor1">Corresponding author. Cardiology Service, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland. Tel: +41 22 372 95 97, Fax: +41 22 372 37 45, Email: <email>philippe.meyer@hcuge.ch</email>
</corresp>
</author-notes>
<pub-date pub-type="epub" iso-8601-date="2020-04-14"><day>14</day>
<month>4</month>
<year>2020</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>14</day>
<month>4</month>
<year>2020</year>
</pub-date>
<pmc-comment> PMC Release delay is 0 months and 0 days and was based on the . </pmc-comment>
<elocation-id>ehaa306</elocation-id>
<permissions><copyright-statement>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.</copyright-statement>
<copyright-year>2020</copyright-year>
<license license-type="publisher-standard" xlink:href="https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model"><license-p>This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (<ext-link ext-link-type="uri" xlink:href="https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model">https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model</ext-link>
)</license-p>
</license>
<license><license-p>This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.</license-p>
</license>
</permissions>
<self-uri xlink:href="ehaa306.pdf"></self-uri>
<counts><page-count count="1"></page-count>
</counts>
<custom-meta-group><custom-meta><meta-name>article-lifecycle</meta-name>
<meta-value>PAP</meta-value>
</custom-meta>
</custom-meta-group>
</article-meta>
</front>
<body><p>Takotsubo syndrome (TTS) is an important differential diagnosis of myocardial injury, which may play a significant role in the COVID-19 pandemic. This report describes a typical case of TTS triggered by SARS-CoV-2 infection.</p>
<p>An 83-year-old lady treated for chronic hypertension was hospitalized for acute chest pain on 18 March 2020, 21 days after the COVID-19 outbreak started in Geneva, Switzerland. She described a 5/10 oppressive mediosternal non-radiating chest discomfort associated with mild breathlessness and dry cough since 15 March. Physical examination was unremarkable. ECG (<italic>Panel</italic>
<italic>A</italic>
) showed <1 mm ST-segment elevation in all precordial leads with deep T-wave inversions. High-sensitive cardiac troponin T was elevated at 1142 ng/L (<14 ng/L). Chest X-ray did not detect any pulmonary opacity. Echocardiography revealed typical left ventricular apical ballooning with hyperkinetic basal segments. Coronary angiography showed non-significant lesions (<italic>Panel B</italic>
) with a typical takotsubo syndrome (TTS) image on ventriculography (<italic>Panel C</italic>
). At day 3, the patient started developing fever, showing increasing biological signs of inflammation, and clear bilateral lung X-ray opacities (<italic>Panel D</italic>
). Nasopharyngeal swab was negative for SARS-CoV-2, but the initial positive immunoglobin A and negative immunoglobulin G serology pattern proved acute infection. The patient recovered progressively on conventional heart failure medication without the need for oxygen/ventilation, and echocardiography showed only mild residual apical hypokinesis on the day of discharge (day 10).</p>
<p>This is to our knowledge the first case of TTS described in the COVID-19 pandemic. The huge emotional stress at the population level and respiratory infections caused by COVID-19 may represent potential triggers in this context. Myocardial injury, frequently reported in patients with COVID-19, is usually attributed to sepsis and/or hypoxaemia and/or underlying coronary artery disease, as well as myocarditis. We believe that TTS may also play a significant role in the COVID-19 pandemic.</p>
<fig id="ehaa306-F1" orientation="portrait" position="float"><graphic xlink:href="ehaa306f1"></graphic>
</fig>
<sec disp-level="2"><title></title>
<p>We would like to thank Nicolas Johner, MD who helped in designing the figure.</p>
<p>Authors’ contributions: all authors participated in writing and approved the final manuscript. Written consent for publication was obtained from the patient.</p>
</sec>
</body>
</pmc>
</record>
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