Fatal Takotsubo syndrome in critical COVID-19 related pneumonia

Luca Titi, Eugenia Magnanimi, Massimo Mancone, Fabio Infusino, Giulia Coppola, Franca Del Nonno, Daniele Colombo, Roberta Nardacci, Laura Falasca, Giulia d'Amati, Maria Grazia Tarsitano, Lucia Merlino, Francesco Fedele, Francesco Pugliese

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Article number107314
Pages (from-to)1-16
Number of pages16
JournalCardiovascular Pathology
Volume51
DOIs
Publication statusE-pub ahead of print - Nov 28 2020

Keywords

  • Autopsy
  • COVID-19
  • COVID-19 related pneumonia
  • Stress cardiomyopathy
  • Takotsubo Syndrome

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Cardiology and Cardiovascular Medicine

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