Role of Depression and Anxiety Disorders in Takotsubo Syndrome: The Psychiatric Side of Broken Heart.

Federico Oliveri,Farah Ahsan,Harshit K Goud,Aldanah Althwanay,Lubna Mohammed,Moiz Javed,Zainab Mehkari,Ian H Rutkofsky

doi:10.7759/cureus.10400

Abstract

Takotsubo syndrome (TTS), also called broken heart syndrome, is an acute and transient cardiac wall motion abnormality of the left ventricle. The patient prototype is a post-menopausal woman with myocardial infarction-like symptoms (angina pectoris, breathlessness, palpitations, etc.) who has experienced sudden emotional or physical stress. Although prognosis is generally considered relatively benign, both complications and recurrence rates are not insignificant. Pathophysiological mechanisms underlying TTS are not entirely understood, but the sympathetic system over-activity has a leading role. Moreover, since emotional stress frequently triggers TTS and since precedent diagnosis of psychiatric disorders sometimes coexists, the psychological response to stress could be another potential therapeutic target. Indeed, this article aims to explore the association between underlying depression and anxiety disorders and TTS, as well as to find ideal therapeutic options useful to treat and prevent TTS. Thus in our review, we considered case reports, case-control studies, and review articles from PubMed. Papers dealing with Takotsubo syndrome and anxiety disorder or depression were selected. We included papers published since 2010 and whose abstract was in English. We concluded that anxiety disorders, but not depression, are associated with a higher occurrence of TTS. There is a link between anxiety, TTS, and inflammation leading to increased sympathetic activity. Nevertheless, patients with pre-admission psychiatric disorders have a higher risk of recurrent TTS. Importantly, the use of selective serotonin reuptake inhibitors (SSRIs) could be a potential therapeutic aid in preventing TTS's recurrence in selected patients.

Highlights

BackgroundTakotsubo syndrome (TTS), called apical ballooning syndrome (ABS), broken heart syndrome, or stress cardiomyopathy, is a syndrome characterized by transient regional systolic dysfunction of the left ventricle (LV), resembling myocardial infarction (MI), but in the absence of angiographic evidence of acute plaque rupture or hemodynamically significant obstructive coronary artery disease (CAD) [1]
The results showed that in patients with a past medical history positive for anxiety disorders, TTS was mainly triggered by a emotional stress; in patients without pre-existing anxiety disorders, undetermined event are more likely to trigger TTS; and physical triggers are more frequently associated with the second group but without statistically significant difference (Table 4) [29]
As many cases of TTS are triggered by emotional stress, we wondered if there was a higher prevalence of psychiatric disorders in these patients to exploit, in the absence of specific therapy, new therapeutic targets usable to prevent TTS onset and recurrence

Summary

Introduction

Takotsubo syndrome (TTS), called apical ballooning syndrome (ABS), broken heart syndrome, or stress cardiomyopathy, is a syndrome characterized by transient regional systolic dysfunction of the left ventricle (LV), resembling myocardial infarction (MI), but in the absence of angiographic evidence of acute plaque rupture or hemodynamically significant obstructive coronary artery disease (CAD) [1]. The typical patient with primary TTS is a post-menopausal woman who has experienced severe, sudden emotional or physical stress [4]. It can happen in a background of high personal stress or, in some cases, in patients with a previous diagnosis of psychiatric disorders [5,7].

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