{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T04:29:42Z","timestamp":1774326582128,"version":"3.50.1"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,2,22]],"date-time":"2021-02-22T00:00:00Z","timestamp":1613952000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> Takotsubo cardiomyopathy is triggered by emotional or physical stress. It is defined as a reversible myocardial dysfunction, usually with apical ballooning aspect due to apical akinesia associated with hyperkinetic basal left ventricular contraction. Described in cases of viral infections such as influenza, only few have been reported associated with novel coronavirus disease 2019 (COVID-19) in the recent pandemic.<\/jats:p><jats:p><jats:bold>Case summary:<\/jats:bold> A 79-years-old man, with cardiovascular risk factors (type 2 diabetes and hypertension) and chronic kidney disease, presented to the emergency room for severe dyspnea after 8 days of presenting respiratory symptoms and fever. Baseline electrocardiogram (ECG) was normal, but he presented marked inflammatory syndrome. He was transferred to an intensive care unit to receive mechanical ventilation within 6 h, due to acute respiratory distress syndrome. He presented circulatory failure 2 days after, requiring norepinephrine support (up to up to 1.04 \u03bcg\/kg\/min). Troponin T was elevated (637 ng\/l). ECG showed diffuse T wave inversion. Echocardiography showed reduced left ventricular ejection fraction (LVEF 40%), with visual signs of Takotsubo cardiomyopathy. Cardiac failure resolved after 24 h with troponin T decrease (433 ng\/l) and restoration of cardiac function (LVEF 60% with regression of Takotsubo features). Patient died after 15 days of ICU admission, due to septic shock from ventilator-acquired pneumonia. Cardiac function was then normal.<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> Mechanisms of Takotsubo cardiomyopathy in viral infections include catecholamine-induced myocardial toxicity and inflammation related to sepsis. Differential diagnoses include myocarditis and myocardial infarction. Evidence of the benefit of immunomodulatory drugs and dexamethasone are growing to support this hypothesis in COVID-19.<\/jats:p>","DOI":"10.3389\/fcvm.2021.614562","type":"journal-article","created":{"date-parts":[[2021,2,22]],"date-time":"2021-02-22T04:35:48Z","timestamp":1613968548000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":14,"title":["Case Report: Takotsubo Syndrome Associated With Novel Coronavirus Disease 2019"],"prefix":"10.3389","volume":"8","author":[{"given":"Sofia","family":"Ortuno","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mathieu","family":"Jozwiak","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean-Paul","family":"Mira","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lee S.","family":"Nguyen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,2,22]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s42399-020-00557-w","article-title":"Takotsubo syndrome in patients with COVID-19: a systematic review of published cases","author":"Singh","year":"2020","journal-title":"SN Compr Clin Med."},{"key":"B2","doi-asserted-by":"publisher","first-page":"929","DOI":"10.1056\/NEJMoa1406761","article-title":"Clinical features and outcomes of takotsubo (stress) cardiomyopathy","volume":"373","author":"Templin","year":"2015","journal-title":"N Engl J Med."},{"key":"B3","doi-asserted-by":"publisher","first-page":"2047","DOI":"10.1093\/eurheartj\/ehy077","article-title":"International expert consensus document on takotsubo syndrome (Part II): diagnostic workup, outcome, and management","volume":"39","author":"Ghadri","year":"2018","journal-title":"Eur Heart J."},{"key":"B4","doi-asserted-by":"publisher","first-page":"592","DOI":"10.1093\/ehjci\/jeaa072","article-title":"COVID-19 pandemic and cardiac imaging: EACVI recommendations on precautions, indications, prioritization, and protection for patients and healthcare personnel","volume":"21","author":"Skulstad","year":"2020","journal-title":"Eur Heart J Cardiovasc Imaging."},{"key":"B5","doi-asserted-by":"publisher","first-page":"e4918","DOI":"10.7759\/cureus.4918","article-title":"Stressing out from the flu: a case of influenza a-associated transient cardiomyopathy","volume":"11","author":"Faircloth","year":"2019","journal-title":"Cureus"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1321","DOI":"10.1016\/j.jaccas.2020.04.023","article-title":"Takotsubo syndrome in the setting of COVID-19 infection","volume":"2","author":"Minhas","year":"2020","journal-title":"JACC Case Reports."},{"key":"B7","doi-asserted-by":"publisher","first-page":"001665","DOI":"10.12890\/2020_001665","article-title":"Takotsubo syndrome associated with COVID-19","volume":"7","author":"Roca","year":"2020","journal-title":"Eur J Case Rep Intern Med"},{"key":"B8","doi-asserted-by":"publisher","first-page":"628","DOI":"10.1016\/j.jacc.2020.05.068","article-title":"Takotsubo cardiomyopathy in COVID-19","volume":"76","author":"Giustino","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1161\/CIRCULATIONAHA.112.111591","article-title":"High levels of circulating epinephrine trigger apical cardiodepression in a \u03b22-adrenergic receptor\/Gi-dependent manner: a new model of Takotsubo cardiomyopathy","volume":"126","author":"Paur","year":"2012","journal-title":"Circulation"},{"key":"B10","doi-asserted-by":"publisher","first-page":"2155","DOI":"10.1093\/eurheartj\/ehp240","article-title":"Abnormalities in intracellular Ca2+ regulation contribute to the pathomechanism of Tako-Tsubo cardiomyopathy","volume":"30","author":"Nef","year":"2009","journal-title":"Eur Heart J."},{"key":"B11","doi-asserted-by":"publisher","first-page":"37277","DOI":"10.1038\/srep37277","article-title":"The synthetic antimicrobial peptide 19-2.5 attenuates septic cardiomyopathy and prevents down-regulation of SERCA2 in polymicrobial sepsis","volume":"6","author":"Martin","year":"2016","journal-title":"Sci. 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