Did COVID and Low Sodium Break My Heart?

Takotsubo cardiomyopathy is a transient cardiomyopathy that affects a substantial number of patients each year and has become increasingly recognized in clinical practice. Although its exact pathophysiology remains incompletely understood, the most widely accepted hypothesis attributes the condition to catecholamine-mediated myocardial stunning in response to emotional or physiological stress. Reported triggers are diverse and include medication exposure, infections, and electrolyte abnormalities. In this report, we present a patient diagnosed with Takotsubo cardiomyopathy in whom the precipitating stressor was initially unclear. On presentation, the patient was found to be COVID-19 positive and had severe hyponatremia, both of which were thought to have contributed to the development of her cardiomyopathy. We review the diagnostic approach used in this case and discuss the various diagnostic criteria currently available for Takotsubo cardiomyopathy. Additionally, we highlight aspects of these criteria that may not be universally required for diagnosis, with implications for reducing unnecessary testing, overall cost of care, and hospital expenditures.