Le psychiatre de liaison et le Tako Tsubo…

Abstract

Stress cardiopathy, also called "Tako Tsubo" is a cardiac pathology linked to an acute coronary syndrome with electrocardiographic signs and an increase in the level of cardiac enzymes, without any abnormality on coronarography. This syndrome is secondary to great physical or mental stress. Mortality and the risk of recurrence are low. However, there is no consensus for treatment or prevention.We report the case of 75-year-old woman presenting recurrent cardiogenic shocks. A symptomatic sinusal dysfunction motivated the introduction of a pacemaker in March 2008. One month later, she was hospitalized for a new cardiogenic shock with left ventricular dysfunction, a 40% ejection fraction, and a third degree mitral insufficiency. Cardiac enzymes were initially elevated. Electrocardiogram showed an ST elevation. The transthoracic echocardiogram revealed a left anterolateral ventriculogram dysfunction, and cardiac catheterization showed healthy coronary arteries. The cardiologist wondered about the existence of an anxiodepressive syndrome. No personal psychiatric background was known. The patient was widowed 3 years earlier. She described herself as a naturally anxious person. She hadn't experienced any recent stressing event. She was not depressed and wasn't taking any psychotropic drug. Her family was caring for her. The next day, the patient had another cardiogenic shock and died a few hours later. Maybe the introduction of the pacemaker occasioned one more stress for this patient…We know that people with a stressing job have probably more chance to suffer a myocardial infarction (the risks are 1.5 or two times greater for them). The prevalence of cardiomyopathy syndrome is 4.9% for women. These women have gone through the menopause, with a history of hypertension and anxiodepressive symptoms. However, we do not find any similar description (behavioural scheme type A) as is shown by the psychosomatic school in cases of patients who have gone through myocardial infarction. We also can question ourselves about the fact that some people can be predisposed to suffer from "Tako Tsubo" cardiomyopathy and about the existence of personality disorders. What then is the role of the psychiatrist with these patients?