TY - JOUR
T1 - Fatal Takotsubo syndrome in critical COVID-19 related pneumonia
AU - Titi, Luca
AU - Magnanimi, Eugenia
AU - Mancone, Massimo
AU - Infusino, Fabio
AU - Coppola, Giulia
AU - Del Nonno, Franca
AU - Colombo, Daniele
AU - Nardacci, Roberta
AU - Falasca, Laura
AU - d'Amati, Giulia
AU - Tarsitano, Maria Grazia
AU - Merlino, Lucia
AU - Fedele, Francesco
AU - Pugliese, Francesco
N1 - Funding Information:
The authors declare that they have no conflicts of interest and nothing to disclose. We tank all members of Covid team of Policlinico Umberto I, ?Sapienza? University of Rome (Alessandri F, Pasqualitto F, De Lazzaro F, Auricchio D, Di Santo C, Sabani A, Ratini F, Ianni S, Mandarelli F, Albante A, Pecorari F, Vaccaro P, Tosi A, De Lauri D, Romano H) for the dedication, preparation, perseverance and resilience in responding to the Covid-19 pandemia.
Publisher Copyright:
© 2020
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/11/28
Y1 - 2020/11/28
N2 - COVID-19 can involve several organs and systems, often with indirect and poorly clarified mechanisms. Different presentations of myocardial injury have been reported, with variable degrees of severity, often impacting on the prognosis of COVID-19 patients. The pathogenic mechanisms underlying cardiac damage in SARS-CoV-2 infection are under active investigation. We report the clinical and autopsy findings of a fatal case of Takotsubo Syndrome occurring in an 83-year-old patient with COVID-19 pneumonia. The patient was admitted to Emergency Department with dyspnea, fever and diarrhea. A naso-pharyngeal swab test for SARS-CoV-2 was positive. In the following week his conditions worsened, requiring intubation and deep sedation. While in the ICU, the patient suddenly showed ST segment elevation. Left ventricular angiography showed decreased with hypercontractile ventricular bases and mid-apical ballooning, consistent with diagnosis of Takotsubo syndrome. Shortly after the patient was pulseless. After extensive resuscitation maneuvers, the patient was declared dead. Autopsy revealed a subepicardial hematoma, in absence of myocardial rupture. On histology, the myocardium showed diffuse edema, multiple foci of contraction band necrosis in both ventricles and occasional coagulative necrosis of single cardiac myocytes. Abundant macrophages CD68+ were detected in the myocardial interstitium. The finding of diffuse contraction band necrosis supports the pathogenic role of increased catecholamine levels; the presence of a significant interstitial inflammatory infiltrate, made up by macrophages, remains of uncertain significance.
AB - COVID-19 can involve several organs and systems, often with indirect and poorly clarified mechanisms. Different presentations of myocardial injury have been reported, with variable degrees of severity, often impacting on the prognosis of COVID-19 patients. The pathogenic mechanisms underlying cardiac damage in SARS-CoV-2 infection are under active investigation. We report the clinical and autopsy findings of a fatal case of Takotsubo Syndrome occurring in an 83-year-old patient with COVID-19 pneumonia. The patient was admitted to Emergency Department with dyspnea, fever and diarrhea. A naso-pharyngeal swab test for SARS-CoV-2 was positive. In the following week his conditions worsened, requiring intubation and deep sedation. While in the ICU, the patient suddenly showed ST segment elevation. Left ventricular angiography showed decreased with hypercontractile ventricular bases and mid-apical ballooning, consistent with diagnosis of Takotsubo syndrome. Shortly after the patient was pulseless. After extensive resuscitation maneuvers, the patient was declared dead. Autopsy revealed a subepicardial hematoma, in absence of myocardial rupture. On histology, the myocardium showed diffuse edema, multiple foci of contraction band necrosis in both ventricles and occasional coagulative necrosis of single cardiac myocytes. Abundant macrophages CD68+ were detected in the myocardial interstitium. The finding of diffuse contraction band necrosis supports the pathogenic role of increased catecholamine levels; the presence of a significant interstitial inflammatory infiltrate, made up by macrophages, remains of uncertain significance.
KW - Autopsy
KW - COVID-19
KW - COVID-19 related pneumonia
KW - Stress cardiomyopathy
KW - Takotsubo Syndrome
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U2 - 10.1016/j.carpath.2020.107314
DO - 10.1016/j.carpath.2020.107314
M3 - Article
C2 - 33259936
AN - SCOPUS:85097788241
VL - 51
SP - 1
EP - 16
JO - Cardiovascular Pathology
JF - Cardiovascular Pathology
SN - 1054-8807
M1 - 107314
ER -