27 March 2026
: Case report 
Reverse Takotsubo Syndrome Triggered by COVID-19–Associated Cytokine Storm: Unveiling a Novel Pattern of Myocardial Dysfunction in SARS-CoV-2 Infection
Unusual clinical course, Challenging differential diagnosis, Management of emergency care, Rare disease, Educational Purpose (only if useful for a systematic review or synthesis)
Killen H. Briones-Claudett
ABCDEFG 1,2*, Killen H. Briones-Zamora ABCDEFG 3, Jaime Benites Solís ABCDEFG 2,4, María Antonieta Touriz Bonifaz ABCDEFG 5,6, Enny Berrus Zhumi ABCDEFG 2, Anahí D. Briones-Zamora ABCDEFG 2,3, Diana C. Briones Márquez ABCDEFG 2,4, Angela Germania Monserrate Romero ABCDEFG 5, Miguel Anderson Tayupanta Alban ABCDEFG 5, Hans Mautong ABCDEFG 7
DOI: 10.12659/AJCR.951623
Am J Case Rep 2026; 27:e951623
Table 2 Clinical timeline of the patient with reverse Takotsubo cardiomyopathy associated with COVID-19.
| Phase | Day/timepoint | Clinical events and evolution | Relevant findings | Treatment |
|---|---|---|---|---|
| Day 1 | Admission due to high-grade fever, fatigue, dry cough, chest pain | Tachycardia, tachypnea, hypotension, dehydration. | Paracetamol 1 g every 8 hours, supplemental oxygen as needed | |
| Chest CT showing bilateral ground-glass opacities with left basal consolidation | ||||
| Positive RT-PCR for SARS-CoV-2 | ||||
| Days 2–3 | Persistent fever and tachycardia, systemic inflammation | Ferritin: 5421 ng/mL; lymphopenia; elevated CRP | Ritonavir 100 mg twice daily, subcutaneous prophylactic fondaparinux 2.5 mg daily | |
| Day 4 | Onset of cardiac dysfunction | Troponin T: 28 ng/L; NT-proBNP: 1582 pg/mL | Colchicine 0.5 mg/day, spironolactone 25 mg/day | |
| Basal hypokinesia, preserved apical motion – consistent with reverse Takotsubo | ||||
| Days 5–6 | Inflammatory peak, persistent tachycardia, ventricular dysfunction | Ferritin: 14 707 ng/mL; CRP: 95 mg/L | Continuation of colchicine and spironolactone | |
| Days 7–10 | Initial clinical improvement, reduced inflammation | LVEF improved to 55% | Adjustment of cardioprotective therapy | |
| Days 11–12 | Clinically stable, afebrile, functional recovery | Ferritin: 1210 ng/mL; NT-proBNP: 106 pg/mL | Discharge with outpatient follow-up and maintenance colchicine therapy | |
| 6-month follow-up | Asymptomatic, under cardiologic evaluation | LVEF: 63%; mild concentric remodeling; Grade I diastolic dysfunction; left atrial volume: 33 mL/m; TAPSE: 23 mm; PASP: 16 mmHg (all within normal limits) | Continued colchicine; no additional intervention required | |
| 12-month follow-up | Preoperative cardiologic reassessment for elective surgery | Sinus rhythm at 73 bpm; axis −20°; QTc: 434 ms; no ischemic or conduction abnormalities | Patient cleared for surgery; colchicine discontinued; no evidence of cardiac sequelae | |
| CT – computed tomography; RT-PCR – reverse transcriptase polymerase chain reaction; CRP – C-reactive protein; LVEF – left ventricular ejection fraction; TAPSE – tricuspid annular plane systolic excursion; PASP – pulmonary artery systolic pressure; ECG – electrocardiogram. | ||||