Covid-19: A Double Threat to Takotsubo Cardiomyopathy and Spontaneous Coronary Artery Dissection? Publisher Pubmed



Shojaei F¹ ; Habibi Z² ; Goudarzi S¹ ; Firouzabadi FD³ ; Montazerin SM¹ ; Najafi H¹ ; Kahe F¹ ; Momenzadeh K⁴ ; Mir M¹ ; Khan F⁵ ; Jamil U⁶ ; Jamil A⁶ ; Lee JJ⁷ ; Chi G¹
Source: Medical Hypotheses Published:2021

Abstract

Coronavirus disease 2019 (COVID-19) is an ongoing pandemic that has affected millions of individuals worldwide. Prior studies suggest that COVID-19 may be associated with an increased risk for various cardiovascular disorders, such as myocardial injury, arrhythmia, acute coronary syndrome, and venous thromboembolism. Early reports of non-COVID-19 patients have described the concurrence of takotsubo cardiomyopathy (TTC) and spontaneous coronary artery dissection (SCAD). However, the interplay between COVID-19, TTC and SCAD has not been well established. We herein propose two sets of two-hit hypotheses for the development of SCAD and TTC in the context of COVID-19. The first two-hit hypothesis explains the development of SCAD, in which TTC-associated formation of vulnerable coronary substrate serves as the first hit (predisposing factor), and COVID-19-associated inflammation and vascular disruption serves as the second hit (precipitating factor). The second two-hit hypothesis is proposed to explain the development of TTC, in which SCAD-associated formation of vulnerable myocardial substrate serves as the first hit, and COVID-19-associated sympathetic overactivity serves as the second hit. Under this conceptual framework, COVID-19 poses a double threat for the development of SCAD (among patients with underlying TTC) as well as TTC (among patients with underlying SCAD), thereby forming a reciprocal causation. This hypothesis provides a rationale for the joint assessment of TTC and SCAD in COVID-19 patients with pertinent cardiovascular manifestations. © 2020 Elsevier Ltd