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To the Editor,
I have read the recent publication in the Journal by Bhattacharyya PJ, et al. BMJ Case Rep 2020;13:e239104. doi:10.1136/bcr-2020-239104 with interest, however I would propose a different interpretation of their case.
The authors present a case of the Takotsubo cardiomyopathy (TC) in a 38 weeks pregnant patient with COVID 19 positive presentation.
They showed that the apical dyskinesis was reversible 2 weeks after her presentation which is one of the features of TC. Nevertheless, the invasive coronary angiography that coincided with the day of the repeat echocardiography (2 weeks after presentation) in my opinion could be in keeping with a revascularized spontaneous coronary artery dissection (SCAD) of the mid LAD, hence the improved flow and recovery of the previously stunned apical left ventricular myocardium. The limited coronary angiographic images show a typical appearance of re-canalising SCAD with the abrupt caliber change of the LAD and the long segments circular and smooth caliber difference indicated by the white arrows on the original image.
It is known that pregnancy predisposes ladies to SCAD and lately we learnt that the COVID-19 inflammatory milieu enhances endothelial vulnerability.
This is an interesting case and the cardiologists and general physicians should all be aware of this type of presentation during COVID 19.