COVID-19 can involve several organs and systems, often with indirect and poorly clarified mechanisms. Different presentations of myocardial injury have been reported, with variable degrees of severity, often impacting on the prognosis of COVID-19 patients. The pathogenic mechanisms underlying cardiac damage in SARS-CoV-2 infection are under active investigation. We report the clinical and autopsy findings of a fatal case of Takotsubo Syndrome occurring in an 83-year-old patient with COVID-19 pneumonia. The patient was admitted to Emergency Department with dyspnea, fever and diarrhea. A naso-pharyngeal swab test for SARS-CoV-2 was positive. In the following week his conditions worsened, requiring intubation and deep sedation. While in the ICU, the patient suddenly showed ST segment elevation. Left ventricular angiography showed decreased with hypercontractile ventricular bases and mid-apical ballooning, consistent with diagnosis of Takotsubo syndrome (TTS). Shortly after the patient was pulseless. After extensive resuscitation maneuvers, the patient was declared dead. Autopsy revealed a subepicardial hematoma, in absence of myocardial rupture. On histology, the myocardium showed diffuse edema, multiple foci of contraction band necrosis in both ventricles and occasional coagulative necrosis of single cardiac myocytes. Abundant macrophages CD68+ were detected in the myocardial interstitium. The finding of diffuse contraction band necrosis supports the pathogenic role of increased catecholamine levels; the presence of a significant interstitial inflammatory infiltrate, made up by macrophages, remains of uncertain significance.

Fatal Takotsubo syndrome in critical COVID-19 related pneumonia / Titi, Luca; Magnanimi, Eugenia; Mancone, Massimo; Infusino, Fabio; Coppola, Giulia; Del Nonno, Franca; Colombo, Daniele; Nardacci, Roberta; Falasca, Laura; d'Amati, Giulia; Tarsitano, Maria Grazia; Merlino, Lucia; Fedele, Francesco; Pugliese, Francesco. - In: CARDIOVASCULAR PATHOLOGY. - ISSN 1054-8807. - 51:(2020). [10.1016/j.carpath.2020.107314]

Fatal Takotsubo syndrome in critical COVID-19 related pneumonia

Titi, Luca
Primo
;
Magnanimi, Eugenia
Secondo
Membro del Collaboration Group
;
Mancone, Massimo
Investigation
;
Infusino, Fabio
Investigation
;
Coppola, Giulia
Investigation
;
d'Amati, Giulia
Writing – Review & Editing
;
Tarsitano, Maria Grazia
Membro del Collaboration Group
;
Merlino, Lucia
Membro del Collaboration Group
;
Fedele, Francesco
Penultimo
Supervision
;
Pugliese, Francesco
Ultimo
Supervision
2020

Abstract

COVID-19 can involve several organs and systems, often with indirect and poorly clarified mechanisms. Different presentations of myocardial injury have been reported, with variable degrees of severity, often impacting on the prognosis of COVID-19 patients. The pathogenic mechanisms underlying cardiac damage in SARS-CoV-2 infection are under active investigation. We report the clinical and autopsy findings of a fatal case of Takotsubo Syndrome occurring in an 83-year-old patient with COVID-19 pneumonia. The patient was admitted to Emergency Department with dyspnea, fever and diarrhea. A naso-pharyngeal swab test for SARS-CoV-2 was positive. In the following week his conditions worsened, requiring intubation and deep sedation. While in the ICU, the patient suddenly showed ST segment elevation. Left ventricular angiography showed decreased with hypercontractile ventricular bases and mid-apical ballooning, consistent with diagnosis of Takotsubo syndrome (TTS). Shortly after the patient was pulseless. After extensive resuscitation maneuvers, the patient was declared dead. Autopsy revealed a subepicardial hematoma, in absence of myocardial rupture. On histology, the myocardium showed diffuse edema, multiple foci of contraction band necrosis in both ventricles and occasional coagulative necrosis of single cardiac myocytes. Abundant macrophages CD68+ were detected in the myocardial interstitium. The finding of diffuse contraction band necrosis supports the pathogenic role of increased catecholamine levels; the presence of a significant interstitial inflammatory infiltrate, made up by macrophages, remains of uncertain significance.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1464818
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