Intense Emotional Stress Over Potential Coronavirus Disease Vaccination Side Effects Leads to Takotsubo Cardiomyopathy

Takotsubo cardiomyopathy (TCM) is often triggered by intense emotional stress. Here we report a case of TCM induced by stress due to concerns about side effects after being vaccinated for coronavirus disease (COVID)-19.

A 64-year-old woman received COVID-19 vaccines on April 26 and May 17, 2021, and no post-vaccination side effects were noted. However, her anxiety grew as she regularly heard about the potential side effects of the COVID-19 vaccine on various media platforms. On May 27, she presented to Shimane University Hospital with severe chest pain. The electrocardiogram showed negative T waves (Figure A) with positive troponin I. Mild congestion was observed on radiography (Figure B), and echocardiography revealed left ventricular apical akinesia and basal hyperkinesia. Emergency coronary angiography showed no significant stenosis (Figure C), whereas left ventriculography demonstrated apical ballooning (Figure D; Supplementary Movie). The left ventricular wall motion improved without any medical treatment. The patient was discharged on Day 10 without any complications.

Figure.

(A) Electrocardiogram showing negative T waves. (B) Chest radiography showing mild congestive findings. (C) Coronary angiography did not reveal significant stenosis. (D) Ventriculography demonstrated apical ballooning.

TCM caused by intense emotional stress from voluntary quarantine during the COVID-19 crisis has been reported;¹ however, this is the first report on TCM triggered by stress and concern about COVID-19 vaccine side effects. In Japan, many patients are concerned about vaccine side effects, and it may be necessary to pay attention to a possible increase in TCM cases in the future.

Disclosures

K.T. is a member of Circulation Reports’ Editorial Team. The other authors declare no conflicts of interest.

IRB Information

This study was approved by the Shimane University Faculty of Medicine Ethics Committee (Reference no. 5588).

Supplementary Files

Supplementary Movie. Left ventriculography.

Please find supplementary file(s);

http://dx.doi.org/10.1253/circrep.CR-21-0075

Reference

• 1.   Sakamoto T, Endo A, Yoshitomi H, Tanabe K. Takotsubo cardiomyopathy caused by intense emotional stress induced by voluntary quarantine during the coronavirus disease crisis. Circ Rep 2020; 2: 382–383.