Two fatal cases of stress-induced cardiomyopathy in COVID-19 patients

Abstract

Stress-induced cardiomyopathy (SCMP) is characterized by transient left ventricular (LV) 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.