Lockdown isolation stress implicated in takotsubo syndrome

Thursday, 17 Sep 2020

An Australian case report of takotsubo syndrome from the COVID-19 hotspot of Melbourne suggests that while social distancing is necessary to reduce the transmission of SARS-coV-2, the stress of social isolation can impact people’s physical health.

A letter in the MJA reported the case of a 71-year-old woman presenting to the ED at the Alfred Hospital with chest pain.

Investigations included a diffuse ST elevation on ECG and elevated troponin (7800 ng/L). Coronary angiography did not demonstrate any obstructive lesion and she was admitted to the ICU for ongoing haemodynamic support.

Echocardiography performed in the ICU showed a dilated left ventricle with an akinetic apex and preserved contraction of the basal segments suggestive of takotsubo cardiomyopathy.

“On questioning regarding recent stressors, our patient, who lived alone, reported significant anxiety about not being able to visit family due to social distancing, and was particularly saddened by being unable to see her grandchildren,” the authors said.

Dr Jon Rivers, now a consultant in anaesthetics and intensive care medicine at the University Hospitals Bristol (UK), and Dr Joshua Ihle, an intensive care specialist from the Alfred Hospital, said in their letter that social distancing may have many unintended health consequences.

“Social isolation is detrimental to mental health, associated with increased stress levels and anxiety, especially in older people, who may be less able to use technology to stay in contact with friends and family. In our patient, this stress was enough to trigger takotsubo cardiomyopathy.”

They noted takotsubo syndrome had also recently been reported from Switzerland in an elderly woman with COVID‐19.

“The huge emotional stress at the population level and respiratory infections caused by COVID-19 may represent potential triggers in this context,” the Swiss case report said.

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