Takotsubo Cardiomyopathy: Medical and Psychiatric Aspects. Role of Psychotropic Medications in the Treatment of Adults with "Broken Heart" Syndrome.

Valeriy Zvonarev

doi:10.7759/cureus.5177

Abstract

Takotsubo cardiomyopathy (TTC) is reversible stress-induced cardiomyopathy featuring symptoms of acute myocardial infarction without significant coronary artery abnormalities. TTC is frequently precipitated by stressful emotional events but it also has been reported as a result of substance withdrawal, non-cardiac events, and dangerous drug-to-drug interaction. The plasma levels of both epinephrine and norepinephrine were significantly elevated in TTC patients, suggesting that elevated catecholamine levels might be the main contributing factor. However, the mechanisms underlying susceptibility to development and recurrence are not completely understood.It has been suggested that even a therapeutic dose of antidepressant could be a cause of drug-induced tachycardia and TTC. Moreover, some cases have been reported in which the development of TTC was associated with the serotonin syndrome, neuroleptic malignant syndrome, and similar fatal consequences.The aim of this article is to explore the association between underlying psychiatric disorders and TTC and to determine the role of various psychotropic medications in the progression of stress-induced cardiomyopathy. This article also notes and discusses the current theories underlying the pathophysiology of TTC. This review suggests a serious side effect of antidepressants, and to avoid life-threatening cardiovascular events, such as TTC, for patients with affective and anxiety disorders, prior screening for cardiovascular conditions by ECG with close monitoring might be necessary.

Highlights

BackgroundTakotsubo cardiomyopathy (TTC) is characterized by transient apical and mid-ventricular left ventricular (LV) dysfunction in the absence of significant coronary artery disease
This review suggests a serious side effect of antidepressants, and to avoid life-threatening cardiovascular events, such as TTC, for patients with affective and anxiety disorders, prior screening for cardiovascular conditions by ECG with close monitoring might be necessary
The results from this study suggested that the administration of selective serotonin reuptake inhibitors (SSRIs) can increase the probability of inpatient death and, as such, physicians need to consider that these agents have TTC as a possible adverse effect [22]

Summary

Introduction

Takotsubo cardiomyopathy (TTC) is characterized by transient apical and mid-ventricular left ventricular (LV) dysfunction in the absence of significant coronary artery disease. It is triggered by emotional or physical stress. The weakening of often triggered by emotional stress from situations like emotional break-ups, the demise of a loved one, or excessive anxiety It has been recognized as a leading cause of ventricular ruptures, acute heart failure, and lethal ventricular arrhythmias [2]. Before the condition was officially named tako-tsubo, it existed, but the syndrome was diagnosed differently in different geographical areas It has been recognized as a severe heart condition, with similar clinical appearance to other coronary events [2]

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