Cardiovascular complications of severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV2) are known to be associated with poor outcome. A small number of case series and reports have described cases of myocarditis and ischaemic events, however, knowledge on the aetiology of acute cardiac failure in SARS-CoV2 remains limited. We describe the occurrence and risk stratification imaging correlates of ‘takotsubo’ stress cardiomyopathy presenting in a patient with Coronavirus Disease 2019 (COVID-19) in the intensive care unit. An intubated 53-year old patient with COVID19 suffered acute haemodynamic collapse in the intensive care unit, and was thus investigated with transthoracic echocardiography (TTE), 12-lead electrocardiograms (ECG) and serial troponins and blood tests, and eventually coronary angiography due to clinical suspicion of ischaemic aetiology. Echocardiography revealed a reduced ejection fraction, with evident extensive apical akinesia spanning multiple coronary territories. Troponins and NT-proBNP were elevated, and ECG revealed ST elevation: coronary angiography was thus performed. This revealed no significant coronary stenosis. Repeat echocardiography performed within the following week revealed a substantial recovery of ejection fraction and wall motion abnormalities. Despite requirement of a prolonged ICU stay, the patient now remains clinically stable, and is on spontaneous breathing. This case report presents a case of takotsubo stress cardiomyopathy occurring in a critically unwell patient with COVID19 in the intensive care setting. Stress cardiomyopathy may be an acute cardiovascular complication of COVID-19 infection. In the COVID19 critical care setting, urgent bedside echocardiography is an important tool for initial clinical assessment of patients suffering haemodynamic compromise.

中文翻译：

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2019 年冠状病毒病 (COVID-19) 的紧急心脏成像在实践中：一例 takotsubo 应激性心肌病

已知严重急性呼吸窘迫综合征冠状病毒 2 (SARS-CoV2) 的心血管并发症与预后不良有关。少数病例系列和报告描述了心肌炎和缺血性事件的病例，但是，关于 SARS-CoV2 急性心力衰竭的病因学知识仍然有限。我们描述了重症监护病房中 2019 年冠状病毒病 (COVID-19) 患者出现的“takotsubo”应激性心肌病的发生和风险分层成像相关性。一名插管的 53 岁 COVID19 患者在重症监护室出现急性血流动力学衰竭，因此接受了经胸超声心动图 (TTE)、12 导联心电图 (ECG) 和系列肌钙蛋白和血液检查，由于临床怀疑缺血性病因，最终进行冠状动脉造影。超声心动图显示射血分数降低，明显的心尖运动不能跨越多个冠状动脉区域。肌钙蛋白和 NT-proBNP 升高，心电图显示 ST 段抬高：因此进行了冠状动脉造影。这表明没有明显的冠状动脉狭窄。在接下来的一周内进行的重复超声心动图显示射血分数和壁运动异常明显恢复。尽管需要延长 ICU 住院时间，但患者现在仍保持临床稳定，并处于自主呼吸状态。本病例报告介绍了一例重症监护室中 COVID19 重症患者发生的 Takotsubo 应激性心肌病。应激性心肌病可能是 COVID-19 感染的急性心血管并发症。在 COVID19 重症监护环境中，紧急床边超声心动图是对血流动力学受损患者进行初步临床评估的重要工具。