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  <front>
    <journal-meta>
      <journal-id journal-id-type="publisher-id">97</journal-id>
      <journal-id journal-id-type="index">urn:lsid:arphahub.com:pub:B5033382-9D21-53CE-B630-B4E3A1146D51</journal-id>
      <journal-title-group>
        <journal-title xml:lang="en">Bulgarian Cardiology</journal-title>
        <abbrev-journal-title xml:lang="en">Bulgarian Cardiology</abbrev-journal-title>
      </journal-title-group>
      <issn pub-type="ppub">1310-7488</issn>
      <issn pub-type="epub">2683-1015</issn>
      <publisher>
        <publisher-name>Bulgarian Society of Cardiology</publisher-name>
      </publisher>
    </journal-meta>
    <article-meta>
      <article-id pub-id-type="doi">10.3897/bgcardio.29.e105075</article-id>
      <article-id pub-id-type="publisher-id">105075</article-id>
      <article-categories>
        <subj-group subj-group-type="heading">
          <subject>Review Article</subject>
        </subj-group>
        <subj-group subj-group-type="scientific_subject">
          <subject>Cardiomyopathy (кардиомиопатии)</subject>
          <subject>Heart Failure (сърдечна недостатъчност)</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title>Unraveling the mystery of Takutsubo cardiomyopathy: a descendant of COVID-19 heart syndrome</article-title>
      </title-group>
      <contrib-group content-type="authors">
        <contrib contrib-type="author" corresp="yes">
          <name name-style="western">
            <surname>Kanuri</surname>
            <given-names>Sri</given-names>
          </name>
          <email xlink:type="simple">harsha9009@gmail.com</email>
          <xref ref-type="aff" rid="A1">1</xref>
        </contrib>
        <contrib contrib-type="author" corresp="no">
          <name name-style="western">
            <surname>Sirrkay</surname>
            <given-names>Prapthi Jayesh</given-names>
          </name>
          <xref ref-type="aff" rid="A2">2</xref>
        </contrib>
      </contrib-group>
      <aff id="A1">
        <label>1</label>
        <addr-line content-type="verbatim">Indianapolis School of Medicine, Indianapolis, United States of America</addr-line>
        <institution>Indianapolis School of Medicine</institution>
        <addr-line content-type="city">Indianapolis</addr-line>
        <country>United States of America</country>
      </aff>
      <aff id="A2">
        <label>2</label>
        <addr-line content-type="verbatim">University of Minnesota, Minneapolis, United States of America</addr-line>
        <institution>University of Minnesota</institution>
        <addr-line content-type="city">Minneapolis</addr-line>
        <country>United States of America</country>
      </aff>
      <author-notes>
        <fn fn-type="corresp">
          <p>Corresponding author: Sri Kanuri (<email xlink:type="simple">harsha9009@gmail.com</email>).</p>
        </fn>
        <fn fn-type="edited-by">
          <p>Academic editor: Dobri Hazarbasanov</p>
        </fn>
      </author-notes>
      <pub-date pub-type="collection">
        <year>2023</year>
      </pub-date>
      <pub-date pub-type="epub">
        <day>19</day>
        <month>07</month>
        <year>2023</year>
      </pub-date>
      <volume>29</volume>
      <issue>2</issue>
      <fpage>7</fpage>
      <lpage>12</lpage>
      <uri content-type="arpha" xlink:href="http://openbiodiv.net/EE0B85B4-C794-5F0A-8B82-34283D2FFECB">EE0B85B4-C794-5F0A-8B82-34283D2FFECB</uri>
      <history>
        <date date-type="received">
          <day>17</day>
          <month>04</month>
          <year>2023</year>
        </date>
        <date date-type="accepted">
          <day>18</day>
          <month>05</month>
          <year>2023</year>
        </date>
      </history>
      <permissions>
        <copyright-statement>Sri Kanuri, Prapthi Jayesh Sirrkay</copyright-statement>
        <license license-type="creative-commons-attribution" xlink:href="http://creativecommons.org/licenses/by/4.0/" xlink:type="simple">
          <license-p>This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</license-p>
        </license>
      </permissions>
      <abstract>
        <label>Abstract</label>
        <p>Takutsubo, or stress cardiomyopathy (TCM) is one of the important cardiovascular disorders encountered during the COVID-19 pandemic. We performed a PubMed search of relevant articles and presented this review which included epidemiology, etiopathogenesis, diagnosis and treatment of this clinical disorder. Takutsubo is usually more common in women than men. COVID-19 infection or vaccination can incite severe emotional disorders such as anxiety and depression, which flames up impaired neural networks in the limbic system. This stirs up disorganized regulation of autonomic nervous system with predominance and excessive firing of sympathetic nervous system to the ventricular myocardium. Moreover, direct invasion and systemic effects of COVID-19 infection including hormonal influences, autoimmunity, cytokine storm and neighboring infections might also play a significant role in the manifestation of this disorder. It commonly presents signs and symptoms of left ventricular dysfunction. Although most cases are undergoing remission within a few weeks, complications such as LV outflow tract obstruction, thromboembolism and arrhythmias were also reported. Since clinical symptoms are non-specific, a high degree of clinical suspicion is warranted particularly with the co-existing COVID-19 infections. Clinicians often leaned upon battery of tests including ECG, echocardiography and CMR to rule out myocarditis and coronary artery disease. Supportive management including treatment of heart failure and any associated arrhythmias and thromboembolism. Recurrences are common, but the treatment of underlying psychiatric disorders, including relaxation techniques, is the key strategy to avoid future occurrences.</p>
      </abstract>
    </article-meta>
  </front>
</article>
