key: cord-0878622-ixnpz86d
authors: Park, Jae-Hyeong; Moon, Jae Young; Sohn, Kyung Mok; Kim, Yeon-Sook
title: Two Fatal Cases of Stress-induced Cardiomyopathy in COVID-19 Patients
date: 2020-08-19
journal: J Cardiovasc Imaging
DOI: 10.4250/jcvi.2020.0125
sha: 43c8026b057a5ad216c912d775ddf7f6da81118c
doc_id: 878622
cord_uid: ixnpz86d

nan

https://e-jcvi.org

systolic dysfunction with regional wall motion abnormalities that do not match coronary arterial territories. 1) Although this syndrome is similar to acute myocardial infarction, the diagnosis of SCMP requires the absence of obstructive coronary artery disease or acute plaque rupture. 2) There are several types of SCMP: apical ballooning (typical type, about 75-80%), midventricular ballooning (about 10-20%), basal ballooning (inverted type, about 5%), and biventricular type (less than 0.5%). The estimated incidence of SCMP is about 1-2% of patients with suspected acute coronary syndrome. 3)4) Because it can be caused by intensive emotional or physical stress, there can be occurrences of SCMP in patients with novel coronavirus disease-2019 (COVID-19). In one study of 1,216 COVID-19 patients, SCMP incidence was 2% (19 patients). 5) The reported in-hospital SCMP mortality is up to 5%. We present 2 fatal cases of SCMP in COVID-19 patients requiring intensive care.

A 78-year-old woman presented with fever and sore throat for the previous 7 days. She was admitted to another hospital due to worsening dyspnea. Initial vital signs at admission were as follows: blood pressure, 114/76 mmHg, heart rate, 112 beats/min; respiratory rate, 24 breaths/min; and body temperature, 38.4°C. After admission, her systolic blood pressure dropped to 80 mmHg and her oxygen saturation was 60%. She was transferred to the intensive care unit and treated with a ventilator. Then, the patient was transferred to our hospital for further treatment. Initial chest X-ray showed diffuse infiltration of whole lung fields ( Figure 1A) . The electrocardiogram showed sinus rhythm with right bundle branch block, and initial echocardiography was normal LV systolic function without regional wall motion abnormality. Because her oxygen requirement worsened after admission, the attending physician decided to apply a veno-atrial type extracorporeal membrane oxygenator (ECMO). On the second hospital day, new T wave inversion appeared (Figure 1B) , and transthoracic echocardiographic examination showed apical ballooning with severe LV systolic function (Figure 1C and D, Movie 1) . Her troponin-I was 277.2 pg/mL (reference, 2.3-17.5 pg/mL) and N terminal pro B-type natriuretic peptide was 2,033 pg/mL (reference, < 314 pg/mL). She was treated with antiviral agents and an ECMO with supportive care, and apical ballooning disappeared after 7 days. Although the attending physician tried to remove 

Assessment of clinical features in transient left ventricular apical ballooning