Keywords
We read with interest the case report by Boscolo Berto et al. about a 63-year-old female who developed the classical type of Takotsubo cardiomyopathy (TTS) one day after her first jab of the Moderna vaccine [
[1]
]. The patient completely recovered without any treatment [[1]
]. The study is appealing but raises several comments and concerns.We do not agree with the statement that the index case represents the first case with SARS-CoV-2 vaccination-induced TTS [
[1]
]. SARS-CoV-2 vaccination-induced TTS has previously been reported in at least four other cases (Table 1) [2
, 3
, 4
, 5
].Table 1SARS-CoV-2 vaccination triggered TTS reported as per the end of November 2021.
| Age | Sex | Brand | LAOT | TTS Type | Treatment | Outcome | Reference |
|---|---|---|---|---|---|---|---|
| 63 | F | 1. Moderna | 1 d | Classical | None | nr | [ [1] ] |
| 72 | M | 1. AZV | 4 d | Classical | Dual APT | CR | [ [2] ] |
| 65 | F | 1. Moderna | 2 d | Classical | Aspirin, atorvastatin, lisinopril, metoprolol | IR | [ [3] ] |
| 80 | F | 1. Pfizer | 4 d | Classical | None | IR | [ [4] ] |
| 73 | F | 1. Moderna | nr | Classical | Metoprolol, losartan | IR | [ [5] ] |
Abbreviations: APT, antiplatelet therapy; AZV, Astra Zeneca vaccine; CR, complete recovery; IR, incomplete recovery at last follow-up; LAOT, latency between vaccination and onset of TTS; nr, not reported.
Since SARS-CoV-2 vaccinations of any brand are not free of side effects [
[6]
], it would be interesting to know if the index patient reported any complaints in addition to fever and dyspnoea. Since headache is the most frequent neurological side effect and since headache can trigger TTS, we would like to know if the patient complained of a headache. Since the third most frequent neurological side effect of SARS-CoV-2 vaccinations is venous sinus thrombosis (VST), and VST is compulsorily associated with headache, we would like to know if there were any indications for VST. Since Guillain Barre syndrome (GBS) is the second most frequent neurological side effect of SARS-CoV-2 vaccinations [[6]
], and GBS can go along with dysautonomia either in association with motor or sensory deficits or without, we would like to know if pure dysautonomic GBS was appropriately excluded. The authors themselves consider a sympatho-vagal imbalance towards adrenergic predominance as a possible pathophysiological mechanism. Since TTS is triggered by emotional or physical stress in one third each, we would like to know if any potential emotional or physical trigger was excluded; even fear from the vaccination can trigger TTS [[7]
].Overall, this interesting report had some limitations, which challenge the results and their interpretation. Before attributing TTS after a SARS-CoV-2 vaccination to the stress from the vaccination, several differential triggers of TSS should be considered.
Acknowledgements
None.
Statement of Ethics
In accordance if ethical guidelines.
Conflicts of Interest
None.
Funding Sources
No funding was received.
Author Contribution
JF: design, literature search, discussion, first draft, critical comments, final approval; TA: literature search, discussion, critical comments, final approval.
Informed Consent
Not applicable.
The study was approved by the institutional review board.
References
- Takotsubo cardiomyopathy after mRNA COVID-19 vaccination.Heart Lung Circ. 2021; 30: e119-e120
- Takotsubo (stress) cardiomyopathy after ChAdOx1 nCoV-19 vaccination.BMJ Case Rep. 2021; 14: e246580
- COVID-19 vaccine-associated Takotsubo cardiomyopathy.Am J Ther. 2021; 28: 361-364
- Takotsubo cardiomyopathy after vaccination for coronavirus disease 2019 in a patient on maintenance hemodialysis.CEN Case Rep. 2021; : 1-5
- Takotsubo syndrome after receiving the COVID-19 vaccine.J Cardiol Cases. 2021; 24: 223-226
- Neurological side effects of SARS-CoV-2 vaccinations.Acta Neurol Scand. 2022; 145: 5-9
- Intense emotional stress over potential coronavirus disease vaccination side effects leads to Takotsubo cardiomyopathy.Circ Rep. 2021; 3: 476-477
Article info
Publication history
Published online: January 19, 2022
Accepted:
December 20,
2021
Received:
November 19,
2021
Identification
Copyright
© 2022 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Takotsubo Cardiomyopathy After mRNA COVID-19 VaccinationHeart, Lung and CirculationVol. 30Issue 12
- PreviewA healthy 63-year-old woman with no cardiovascular risk factors was admitted to the emergency room with new-onset dyspnoea and fever. The symptoms started 1 day after receiving the first of two mRNA-1273 (Moderna, Cambridge, MA, USA) COVID-19 vaccinations. She had no other prior complaints. A retronasal severe acute respiratory syndrome coronavirus 2 polymerase chain reaction test was negative. Laboratory tests revealed normal results for creatinine, creatine kinase, and creatine kinase MB (myocardial type).
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