Takotsubo cardiomyopathy after vaccination for coronavirus disease 2019 in a patient on maintenance hemodialysis

Abstract

Coronavirus disease-2019 (COVID-19) has affected more than 220 million individuals since the global pandemic began. There is an urgent need for safe and effective vaccines, and vaccinations, such as mRNA vaccines, have been initiated worldwide. However, the adverse effects of these vaccines remain unclear. We herein present a case of an 80-year-old female on maintenance hemodialysis who developed takotsubo cardiomyopathy 4 days after receiving the first dose of the Pfizer-BioNTech COVID-19 vaccine. There was no obvious trigger for the onset of takotsubo cardiomyopathy other than the COVID-19 vaccination, which was the most significant event preceding her presentation. Echocardiograms obtained during her admission allowed us to monitor and show the recovery of left ventricular wall motion. We confirmed the diagnosis of takotsubo cardiomyopathy based on the findings, including transient left ventricular dysfunction, electrocardiographic abnormalities, an elevated troponin level, and the absence of occlusive coronary artery disease. In the present case, the vaccination may have triggered emotional or physical stress. Although difficulties are associated with proving the causal relationship in the present case, the temporal relationship between the vaccination and the onset of takotsubo cardiomyopathy is highly suggestive. The adverse effects associated with the vaccine are typical of COVID-19 vaccines administered to date, most of which are acceptable. Therefore, despite our experience of the present case, we still recommend the vaccination for COVID-19 because takotsubo cardiomyopathy induced by the COVID-19 vaccine is extremely rare and the prognosis of the patient was good. We herein present the first case of a patient on hemodialysis who developed takotsubo cardiomyopathy after receiving COVID-19 vaccination.

Keywords: Adverse effects; COVID-19 vaccine; Hemodialysis; Left ventricular outflow tract obstruction; Takotsubo cardiomyopathy.

Fig. 1

Initial electrocardiogram

Fig. 2

Echocardiography of akinesia of apical segments of the left ventricle (LV) and LV outflow tract systolic anterior motion of the mitral valve (MV) with basal hyperkinesia was observed with mild-moderate mitral regurgitation. Apical three-chamber view at diastole (A) and systole (B) using echocardiography. Color Doppler image of the LV outflow tract at systole (C) and the flow velocity waveform (D)

Fig. 3

Coronary computed tomography with no significant stenosis of coronary arteries. Coronary computed tomography angiography of the left coronary artery (left), left circumflex artery (middle), and right coronary artery (right)