Table 3.
Literature review of cases of secondary TC in patients with COVID-19
| Case by Minhas et al5 | Case by Meyer et al6 |
Case by Solano-López et al7 | Case by Nguyen et al8 |
Case by Roca et al9 |
Case series by Pasqualetto et al10 | |||
| Patient 1 | Patient 2 | Patient 3 | ||||||
| Age in years | 58 | 83 | 50 | 71 | 87 | 84 | 85 | 81 |
| Gender | Female | Female | Male | Female | Female | Male | Female | Male |
| Presenting symptoms | Cough, fatigue, fever, diarrhoea for 5 days | Chest pain, dry cough and mild dyspnoea | Cough, dyspnoea and fever for 8 days | Fainting | Fever, fatigue, dyspnoea | Fever, cough, dyspnoea and atypical chest pain for ~10 days prior to presentation | ||
| Comorbidities | HTN, DM, HLD | HTN | Benign mediastinal tumour since childhood | HTN HLD NPH s/p VP shunt |
h/o breast cancer | HTN, DM | HTN | HTN, DM |
| ET intubation | Yes | No | No | Yes | No | No | Yes | No |
| PaO2/FiO2 | NA | NA | NA | NA | 226 | >300 | <100 | >300 |
| Troponin | NA | 1142 ng/L (ref <14 ng/L) | 64 ng/mL | 412.7 ng/L (ref <14) | 5318 ng/L (<6) | 70 ng/mL* | 647 ng/mL* | 621 ng/mL* |
| NT-pro-BNP | 11.02 ng/mL | NA | 790 pg/mL | NA | NA | 1381 ng/mL* | 3000 ng/mL* | 12586 ng/mL* |
| CRP | NA | NA | NA | NA | 205.6 (n<5) | 168.8 mg/L* | 170.9 mg/L* | 190.4 mg/L* |
| D-Dimer | NA | NA | NA | NA | NA | 1381 ng/mL | 1227 ng/mL | 3340 ng/mL |
| Procalcitonin | NA | NA | NA | NA | NA | 0.35 ng/mL* | 3.01 ng/mL* | 0.07 ng/mL* |
| ECG | 1 mm upsloping ST elevation in lead 1 and aVL, diffuse PR depression an ST-T changes | Diffuse ST elevation (<1 mm) and T inversions | 2 mm inferolateral ST elevation | Sinus rhythm with prolonged QT | Negative T waves and repolarisation alterations | Deep T-inversions in all leads | NA | NA |
| Variant of TC | Typical | Typical | Reverse | Median | Typical | Typical | Unclear probably typical | Typical |
| EF | 20% | NA | NA | NA | 48% | 53% | 30% | 42% |
| Coronary angiogram | Not performed | Non-significant lesions | Negative | Proximal LAD and D1 significant lesion requiring intervention | Not performed | Negative† | Normal coronary anatomy on autopsy | Negative† |
| In-hospital treatment | Dobutamine | NA | NA | NA | Ceftriaxone, azithromycin, methylprednisone | ASA, fondaparinux subcutaneous, nitroglycerin intravenous, metoprolol intravenous | ASA, clopidogrel, fondaparinux subcutaneous, ionotropic support | ASA, fondaparinux subcutaneous, metoprolol intravenous |
| Outcome | Resolution of TC but worsening ARDS‡ | Near complete recovery of LV function at the time of discharge | Improvement in LV function at the time of discharge | NA | Discharge home | Discharge home | Death | Discharge home |
*Peak levels reported.
†A coronary angiogram done after resolution of initial COVID-19 pneumonia.
‡Patient in-hospital at the time of publication of the case. The final outcome is unknown.
AF, atrial fibrillation; ARDS, acute respiratory distress syndrome; ASA, aspirin; CRP, C reactive protein; D1, first diagonal; DM, diabetes mellitus; EF, ejection fraction; ET, endotracheal; FiO2, fractional inspired oxygen; HLD, hyperlipidaemia; HTN, hypertension; LAD, left anterior descending; LV, left ventricle; NA, not available; NPH s/p VP, normal pressure hydrocephalus status post ventriculoperitoneal shunt; PaO2, arterial oxygen pressure; RVR, rapid ventricular rate; TC, Takotsubo cardiomyopathy; TTE, transthoracic echocardiography.