Atypical Takotsubo Cardiomyopathy Secondary to COVID-19 Presenting Late as Chest Pain with Subsequent Late Sudden Death

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Charles Read Cathy M Holt Nadim Malik


Background: Cardiac involvement at time of COVID-19, caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is associated with poor prognosis. However, post-COVID-19, the recovery period might also be associated with lingering effects or predisposition to some cardiac manifestations including sudden death, which can not only be missed but which might also remain undefined.  This is a report of 56-year man who developed chest pain diagnosed as atypical Takotsubo type cardiomyopathy presenting after recovery from COVID-19 pneumonia 12 days following confirmation of SARS-CoV-2 infection by real-time quantitative polymerase chain reaction (RT-qPCR) testing.

Case Report: 56 years old male who re-presented after clinical recovery from COVID-19 pneumonia (diagnosed on 1st admission from a nasopharyngeal swab using RT-qPCR assay/test; Xpertâ Xpress SARS-CoV-2 in vitro diagnostic device), with new cardiac symptoms (3rd admission), which after appropriate investigations was diagnosed as non-coronary cardiac injury/atypical Takotsubo type cardiomyopathy leading to sudden fatal outcome.  Plausible mechanisms include direct cardiac toxicity (myocarditis) and/or microthrombi/hypoxia.  The precise timing of the cardiac injury was difficult to elucidate but the potential for lingering cardiac consequences was realistic with eventual negative prognostic outcome. 

Conclusions: This case presentation after full clinical recovery from COVID-19 pneumonia highlights the new challenges for such cases, including potential longer-term enduring impact on cardiovascular morbidity and late mortality.  The implications on use/benefits from conventional cardio-protective therapies including duration remains unclear. Further studies to screen high-risk patients with elevated cardiac biomarkers or cardiac risk factors post COVID-19 recovery (if not all patients) might be helpful but at the expense of significant consequences on existing cardiac services and cardiologists.

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READ, Charles; HOLT, Cathy M; MALIK, Nadim. Atypical Takotsubo Cardiomyopathy Secondary to COVID-19 Presenting Late as Chest Pain with Subsequent Late Sudden Death. Medical Research Archives, [S.l.], v. 10, n. 4, apr. 2022. ISSN 2375-1924. Available at: <>. Date accessed: 03 dec. 2022. doi:
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