akotsubo cardiomyopathy is a novel heart syndrome characterized by a transient left ventricular (LV) dysfunction with chest pain, ECG changes and not a high increase in cardiac enzymes, mimicking an acute myocardial infarction. 1,2 Because of the specific abnormalities of the LV contraction (ie, preserved basal function with apical akinesis or dyskinesis) the disease is also called as 'transient left ventricular apical ballooning' or 'ampulla cardiomyopathy '. 2,3 The general prognosis is considered to be rather favorable, 2-6 although some investigators have reported cases with various complications including death. [7][8][9] We present a case of takotsubo cardiomyopathy in a female patient who suffered a fatal LV free wall rupture and the results of a comprehensive histopathologic investigation. Case ReportAn 81-year-old woman with hypertension started to feel chest pains after a quarrel with her son. Next day stomach pains and diarrhea appeared but the chest pain became intermittent, and the symptoms were accompanied by general fatigue. On the third day she was admitted to hospital because of chest discomfort at rest and ECG signs of ST-segment elevation myocardial infarction (MI) (Fig 1A). She had no history of prior angina or MI and no family history of heart disease and sudden death. On admission her heart rate was 104 beats/min, and blood pressure was 150/90 mmHg. Auscultation of the heart and lungs was normal, abdominal and neurological examination findings were negative, and there was no peripheral edema. Immediate coronary angiography did not reveal any significant coronary artery stenosis ( Figs 2A,B); the TIMI frame counts for the left anterior descending, circumflex and right coronary arteries were 29, 20 and 26 frames, respectively. However, ventriculography revealed a balloon-like LV motion abnormality with akinesis from the mid to apical portions and hyperkinesis of the base (Figs 2C,D). The LV end-systolic and end-diastolic pressureas were 150 mmHg and 15 mmHg, respectively, and there was no pressure gradient from the apex and midportion to the outflow tract; other hemodynamic data and the laboratory data on admission are shown in Table. After angiography the patient reported pain relief and was taken to the intensive care unit; however, the ECG recording showed no restoration of normal ST-segment (Fig 1B). The woman was stable during the first 40 h of admission, with no hemodynamic or arrhythmic problems, and she was given -blocker (metoprolol), angiotensin-converting enzyme inhibitor (ramipril) and aspirin; her blood pressure was within normal limits. She occasionally complained of chest discomfort; her creatine kinase-MB was maximal on admission and gradually diminished in further examinations, but the ST segment remained elevated ( Figs 1C,D). After 40 h of admission she reported a sudden pain in the epigastric region and the symptoms of acute abdomen soon appeared (C-reactive protein reached 267 mg/dl). After surgical consultation the woman was taken to the operation room for urgent surger...

Aims The coronavirus disease‐2019 (COVID‐19) pandemic has changed the landscape of medical care delivery worldwide. We aimed to assess the influence of COVID‐19 pandemic on hospital admissions and in‐hospital mortality rate in patients with acute heart failure (AHF) in a retrospective, multicentre study. Methods and results From 1 January 2019 to 31 December 2020, a total of 101 433 patients were hospitalized in 24 Cardiology Departments in Poland. The number of patients admitted due to AHF decreased by 23.4% from 9853 in 2019 to 7546 in 2020 ( P < 0.001). We noted a significant reduction of self‐referrals in the times of COVID‐19 pandemic accounting 27.8% ( P < 0.001), with increased number of AHF patients brought by an ambulance by 15.9% ( P < 0.001). The length of hospital stay was overall similar (7.7 ± 2.8 vs. 8.2 ± 3.7 days; P = not significant). The in‐hospital all‐cause mortality in AHF patients was 444 (5.2%) in 2019 vs. 406 (6.5%) in 2020 ( P < 0.001). A total number of AHF patients with concomitant COVID‐19 was 239 (3.2% of AHF patients hospitalized in 2020). The rate of in‐hospital deaths in AHF patients with COVID‐19 was extremely high accounting 31.4%, reaching up to 44.1% in the peak of the pandemic in November 2020. Conclusions Our study indicates that the COVID‐19 pandemic led to (i) reduced hospital admissions for AHF; (ii) decreased number of self‐referred AHF patients and increased number of AHF patients brought by an ambulance; and (iii) increased in‐hospital mortality for AHF with very high mortality rate for concomitant AHF and COVID‐19.

We report the case of a female patient with congenital complete atrioventricular block who developed torsade de pointes (TdP) in the course of takotsubo cardiomyopathy. On the basis of this case, we show that the electrocardiographic evolutionary changes with QT interval prolongation (in the course of takotsubo cardiomyopathy) may be a TdP threatening period in patients with underlying predispositions. After reviewing the literature, we also present the electrocardiographic similarities between takotsubo cardiomyopathy and other acute heart diseases associated with a large amount of stunned myocardium, i.e., other stress-related cardiomyopathies (e.g., those associated with subarachnoid hemorrhage, pheochromocytoma, or severe illnesses) as well as a reperfused myocardial infarction. QT interval prolongation is a common feature in the subacute phase of these entities; however, excessive QT prolongation may be a sign of predisposition to TdP. In such instances, measures should be taken to monitor cardiac rhythm closely and to prevent or treat TdP appropriately. Taking into account the risk of TdP, it is reasonable to consider takotsubo cardiomyopathy as a potential cause of acquired long QT syndrome.

Background:The coronavirus disease-2019 (COVID-19) pandemic is surging across Poland, leading to many direct deaths and underestimated collateral damage. We aimed to compare the influence of the COVID-19 pandemic on hospital admissions and in-hospital mortality in larger vs. smaller cardiology departments (i.e., with ≥2000 vs. <2000 hospitalizations per year in 2019). Methods: We performed a subanalysis of the COV-HF-SIRIO 6 multicenter retrospective study including all patients hospitalized in 24 cardiology departments in Poland between January 1, 2019 and December 31, 2020, focusing on patients with acute heart failure (AHF) and COVID-19. Results: Total number of hospitalizations was reduced by 29.2% in larger cardiology departments and by 27.3% in smaller cardiology departments in 2020 vs. 2019. While hospitalizations for AHF were reduced by 21.8% and 25.1%, respectively. The length of hospital stay due to AHF in 2020 was 9.6 days in larger cardiology departments and 6.6 days in smaller departments (p < 0.001). In-hospital mortality for AHF during the COVID-19 pandemic was significantly higher in larger vs. smaller cardiology departments (10.7% vs. 3.2%; p < 0.001). In-hospital mortality for concomitant AHF and COVID-19 was extremely high in larger and smaller cardiology departments accounting for 31.3% vs. 31.6%, respectively. Conclusions: During the COVID-19 pandemic longer hospitalizations and higher in-hospital mortality for AHF were observed in larger vs. smaller cardiology departments. Reduced hospital admissions and extremely high in-hospital mortality for concomitant AHF and COVID-19 were noted regardless of department size.

Background: There are no data regarding the mortality rate, risks and benefits of particular reperfusion methods and pharmacological treatment complications in patients aged over 100 years with acute coronary syndromes. We sought to assess the treatment of myocardial infarction (MI) in patients older than 100 years and to determine prognostic factors for this group. Methods: Among the 716,566 patients recorded between 2003 and 2018 in the Polish Registry of Acute Coronary Syndromes, 104 patients aged ≥100 with MI were included. The patients were categorized into two groups: group 1 received conservative treatment (64 patients), and group 2 received invasive strategy (40 patients). Results: The frequencies of in-hospital mortality, MI and stroke were similar in both arms. No difference in the frequency of the combined endpoint (death, reinfarction, stroke) was noted. Invasive treatment was more advantageous for 12-month outcomes; 50 patients in group 1 (79%) and 23 patients in group 2 (57.50%) died (p = 0.017). The multivariate analysis identified the lower left ventricular ejection fraction (EF) (Hazard Ratio (HR) = 0.96; 95% Confidence Interval (CI): 0.94–0.99; p = 0.012), lack of coronary angiography (HR = 0.49; 95% CI: 0.24–0.99; p = 0.048) and cardiac arrest (HR = 4.61; 95% CI: 1.64–12.99; p = 0.0038) as predictors of 12-month mortality in this group. Conclusions: Invasive MI treatment may be beneficial for selected very old patients.