Takotsubo cardiomyopathy following a virtual work meeting during COVID-19 pandemic: a case report

Background: Coronavirus disease 2019 ( COVID-19) has a great impact on both, physical and psychological wellbeing. The COVID- 19 pandemic promoted increasing digitalization of the work environment and social isolation. This psychosocial stress in turn can induce physical distress with clinical manifestation. So can the changed work and social environment in the COVID-19 pandemic trigger acute cardiovascular disease? Case Description: Here, we present a case of a 56-year-old postmenopausal woman suffering from Takotsubo cardiomyopathy (TTC) evoked by emotional stress during a virtual work meeting. Like many others, our patient was urged to work from home (WFH) in accordance with the contact restrictions due to COVID-19. She presented at our chest pain unit with typical angina pectoris-like symptoms such as chest pain and dyspnea. Laboratory analysis confirmed increased troponin levels and evolving T wave inversion in electrocardiogram. Acute coronary syndrome management was commenced. Coronary angiography and left ventriculography revealed non-obstructive coronary arteries and apical ballooning syndrome. Due to immediate guideline-directed treatment with bisoprolol, ramipril, spironolactone and acetylsalicylic acid the patient's condition improved so that she could be discharged after seven days. During a 3-month follow-up the patient showed a normalized ejection fraction and reported no discomfort anymore. Conclusions: The ongoing COVID-19 pandemic has also elucidated the importance of the psychosocial health issues in acute cardiovascular care. Having in mind that the social and work environment recently has changed immensely, thus enforcing social isolation and emotional distress, doctors as well as patients must consider TTC as possible etiology of sudden chest pain.