key: cord-0745540-3lsclb89
authors: Finsterer, Josef; Stöllberger, Claudia
title: SARS‐CoV‐2 triggered Takotsubo in 38 patients
date: 2020-10-30
journal: J Med Virol
DOI: 10.1002/jmv.26581
sha: c49932520903dbaa09dc00d5b6b5872e2bc36576
doc_id: 745540
cord_uid: 3lsclb89

SARS-CoV-2 predominantly affects the lungs but direct or indirect involvement of other organs is increasingly recognized [1]. This article is protected by copyright. All rights reserved.

To the Editor, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) predominantly affects the lungs but direct or indirect involvement of other organs is increasingly recognized. 1 There are a number of publications available showing that in addition to the lungs, the urinary, cardiovascular, gastrointestinal, hematological, hematopoietic, neurological, or reproductive systems may be affected. 1 Cardiac involvement reported in SARS-CoV-2 infected patients includes myocardial infarction, myocarditis, heart failure, ventricular arrhythmias, or cardiogenic shock. [2] [3] [4] Additionally, there is increasing evidence that also Takotsubo syndrome (TTS) may be a complication of the viral infection. 5 TTS, also known as stress cardiomyopathy, broken heart syndrome, or stunned myocardium, is characterized by transient hypokinesia/dyskinesia/akinesia of the left ventricular myocardium leading to systolic dysfunction. TTS is believed to be triggered by excessive catecholamine release and overstimulation of myocardial adrenergic receptors. TTS predominantly affects females and is triggered by physical respectively emotional stress in one-third of the cases each. 6 Depending on the location of dyskinesia/akinesia/ hypokinesia, four types of TTS are delineated: the apical type, the mid-ventricular type, the basal type, and the global type. TTS mimics myocardial infarction clinically, chemically, and electrocardiographically. 6 Clinical manifestations of TTS include anginal chest pain and dyspnea. 6 Creatine-kinase, troponin, catecholamines and proBNP are frequently elevated. Electrocardiography shows ST-elevation and negative T-waves. However, coronary angiography is usually normal. TTS is diagnosed according to the Mayo Clinic criteria. The outcome of TTS is usually fair and more favorable in TTS triggered by emotional than by physical stress. 7 Though generally believed to be a rare complication of the SARS-CoV-2 infection, 38 cases with SARS-CoV-2 associated TTS have been reported so far (Table 1) 

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