Takotsubo syndrome in COVID-19 era: Is psychological distress the key? Journal of Psychosomatic Research

L. Barbieri, F. Galli, B. Conconi, T. Gregorini, S. Lucreziotti, A. Mafrici, G. Pravettoni, M. Sommaruga, S. Carugo

Research output: Contribution to journalArticlepeer-review


Covid-19 pandemic, starting from Wuhan, China spread all over the world and Italy was one of the most affected countries, especially in Lombardy, where, on February 20, the first confirmed case was detected. Italian Government ordered a national lockdown on the 9 th March 2020, forcing the population to severe restrictive isolation measures. The burden on mental health of the medical emergency related to COVID19 is progressively been revealed. Takotsubo syndrome (TTS), is estimated to represent 1–3% of patients admitted with suspected STEMI, mostly affecting elderly women with emotional stress and/or acute illness preceding the presentation. Comparing patients hospitalised from February to May 2020 with those of the corresponding period in 2019 we observed a significantly increased number of TTS diagnosis in 2020 (11 patients vs 3 in 2019), especially during the first period of lockdown. The only two males were patients with COVID-19 and were the only two who died in hospital. At psychological examination all patients enrolled report to have lived a particularly stressful experience at IES-R in the last year, without presenting the symptoms of a post-traumatic stress disorder. Most patients were positive to the allostatic overload. Only one patient showed a clinical cut-off for HADS and no one for the Fear COVID-19 scale. We finally concluded that subjects with pre-pandemic psychological distress may have experienced additional psychological overload, opening the door to TTS by a series of physiological alterations as the secretion of cortisol and catecholamines, making the subject more vulnerable to the onset of TTS. © 2020 Elsevier Inc.
Original languageEnglish
JournalJ. Psychosom. Res.
Publication statusPublished - 2021


  • Allostatic overload
  • Covid-19
  • Psychological distress
  • Takotsubo syndrome
  • acute heart infarction
  • aged
  • allostasis
  • Article
  • clinical article
  • coronary angiography
  • coronavirus disease 2019
  • distress syndrome
  • echocardiography
  • fear
  • female
  • hospital admission
  • Hospital Anxiety and Depression Scale
  • hospitalization
  • human
  • Impact of Events Scale
  • male
  • mental stress
  • out of hospital cardiac arrest
  • pandemic
  • personal experience
  • posttraumatic stress disorder
  • psychologic assessment
  • psychologic test
  • retrospective study
  • Severe acute respiratory syndrome coronavirus 2
  • symptom
  • takotsubo cardiomyopathy
  • virus pneumonia
  • Italy
  • psychology
  • risk factor
  • very elderly
  • Aged
  • Aged, 80 and over
  • Allostasis
  • COVID-19
  • Fear
  • Female
  • Hospitalization
  • Humans
  • Male
  • Psychological Distress
  • Retrospective Studies
  • Risk Factors
  • Takotsubo Cardiomyopathy


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