The COVID-19 pandemic has caused a ripple effect that touches all aspects of our lives. We worry about our health and the health of those we love and grief the days we could spend with each other without social distancing. Many are having to deal with the loss of income and financial hardships. Recently, researchers at the Cleveland Clinic conducted a study to answer the question, “Is psychological, social, and economic stress associated with COVID-19 related to the incidence of stress cardiomyopathy?” It may not be a surprise that study researchers did find an increase in the condition over recent months.
Takotsubo cardiomyopathy, also known as stress cardiomyopathy and broken heart syndrome, is a weakening of the left ventricle. The condition is triggered by severe emotional or physical distress, such as a sudden loss, receiving bad news, or sudden illness/surgery. A person usually presents with chest pain and shortness of breath, however, diagnostic tests don’t find any evidence of acute coronary artery obstruction. Other symptoms may include irregular heartbeat, low blood pressure, fainting, and cardiogenic shock.
Most people recover from Takotsubo cardiomyopathy without long-term heart damage and the condition rarely leads to death. This type of cardiomyopathy is usually treated with heart medications to decrease blood pressure and slow heart rate. If indicated, medications may also be used to help with stress management.
About the Study
The researchers used a retrospective cohort study design* and analyzed the EMRs of 258 patients presenting with symptoms of acute coronary syndrome (ACS). Symptoms of ACS include (but not limited to) ST-segment elevation myocardial infarction, non ST-segment elevation myocardial infarction and unstable angina. The 258 patients presented to Cleveland Clinic Main Campus and Cleveland Clinic Akron General with symptoms of acute coronary syndrome between March 1, 2020 to April 30, 2020. The study group was compared to four control groups of ACS patients treated prior to the pandemic.
*All of the patients in the study group tested negative for COVID-19.
The international Takotsubo syndrome diagnostic criteria 2014 was used to diagnose stress cardiomyopathy. The criteria used include:
Transient left ventricular dysfunction presented as:
Midventricular, basal or focal wall motion anomalies
An emotional, physical or combined trigger that precedes the disease onset (but is not required for diagnosis)
Neurological triggers, as well as pheochromocytoma, may be a trigger
New ECG abnormalities
Moderate increase in cardiac biomarkers
Significant elevation of brain natriuretic peptide
No evidence of myocarditis
Significant coronary artery disease may coexist
12 lead ECG, coronary arteriography and echocardiogram findings were interpreted and reported by Cleveland Clinic cardiologists.
The researchers found a significantly higher number of patients (7.8%) diagnosed with stress cardiomyopathy during the COVID-19 pandemic compared to the pre-pandemic incidence of 1.7%. They also found patients diagnosed with stress cardiomyopathy during the pandemic had a longer length of stay compared to patients diagnosed prior to the pandemic. Mortality rates between the groups were not significantly different.
Research has long supported the link between stress cardiomyopathy and elevated levels of stress and anxiety. The study researchers report the increase in stress cardiomyopathy during the pandemic is likely due to psychological, social and economic distress and not the actual COVID-19 virus. This is supported by negative COVID test results for all patients diagnosed with stress cardiomyopathy in the study group.
The study only includes patients from 2 hospitals, limiting the representing population to Northeast Ohio. Further research is needed to study any regional difference in COVID-19 and stress cardiomyopathy. The COVID test used, RT-PCR, is also limited in sensitivity and could have resulted in false negatives within the study group.
What are your thoughts about the research findings? Have you noticed an increase in broken heart syndrome in your area of practice?
Incidence of Stress Cardiomyopathy During the Coronavirus Disease 2019 Pandemic
JAMA Network Open