Takotsubo syndrome in COVID-19 era: Is psychological distress the key?

• Published in: Journal of psychosomatic research Vol. 140; p. 110297
• Main Authors: Barbieri, Lucia, Galli, Federica, Conconi, Barbara, Gregorini, Teresa, Lucreziotti, Stefano, Mafrici, Antonio, Pravettoni, Gabriella, Sommaruga, Marinella, Carugo, Stefano
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 01-01-2021; Elsevier Science Ltd
• Subjects: Aged; Aged, 80 and over; Allostasis; Allostatic overload; Catecholamines; Coronaviruses; Cortisol; COVID-19; COVID-19 - epidemiology; COVID-19 - psychology; Elderly women; Fear - psychology; Female; Hospitalization - statistics & numerical data; Humans; Hydrocortisone; Italy - epidemiology; Male; Males; Medical diagnosis; Mental health; Older people; Pandemics; Patients; Post traumatic stress disorder; Psychological Distress; Retrospective Studies; Risk Factors; Short Communication; Takotsubo Cardiomyopathy - epidemiology; Takotsubo Cardiomyopathy - therapy; Takotsubo syndrome; Italy; Covid-19; Psychological distress; Takotsubo syndrome; Allostatic overload
• ISSN: 0022-3999; 1879-1360
• DOI: 10.1016/j.jpsychores.2020.110297

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.
•The burden of COVID-19 pandemic on mental health has progressively been revealed.•TTS, 1–3% of suspected STEMI, mostly affect elderly with emotional stress.•In our population we observed a significant increase in TTS during pandemic.•Most patients were positive to the allostatic overload.•Pandemic probably brought to additional psychological overload.