The “breathless heart” of a 38-year-old healthcare worker: A case report

COVID-19 has been associated with a wide spectrum of cardiovascular conditions. On the other hand, patients hospitalized with severe acute respiratory distress syndrome (ARDS) may often require long-term intubation. Laryngotracheal stenosis (LTS) is a well described complication of the latter, potentially leading to acute airway obstruction. We present the case of a 38-year-old healthcare worker with acute respiratory failure due to LTS as a complication of prior intubation for COVID-19. Emergent therapeutic bronchoscopy successfully treated airway obstruction. ECG alterations, accompanied by elevated troponin and wall motion abnormalities raised the suspicion for acute coronary syndrome, without signs of active infection. Coronary computed tomography angiography led to the diagnosis of myocardial infarction with non-obstructive coronary arteries (MINOCA). Cardiac magnetic resonance (CMR) revealed patchy non-ischemic lesions. 3-month ECG and echocardiogram were normal suggesting Takotsubo syndrome (TTS) the most likely diagnosis. Patient was finally treated by implantation of an endotracheal silicone hourglass stent. Our case highlights the importance of multidisciplinary medical management. A definite diagnosis of TTS requires the performance of a CMR and the reversal of systolic dysfunction. LTS is a well described complication of long-term intubation and a high index of suspicion is warranted. Treatment is individualized including interventional treatments and surgical techniques. Summary figure. Case timeline. (Created with BioRender.com) • MINOCA is a working diagnosis, which warrants a thorough diagnostic assessment. • A definite diagnosis of TTS requires the performance of a CMR and the reversal of systolic dysfunction. • Laryngotracheal stenosis (LTS) is a well described complication of long-term intubation. • LTS treatment is individualized including interventional treatments and surgical techniques. • Mitomycin C is generally used as a bridge to the definite treatment of LTS.