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Ortega MDC, Bullard JP, Del Mar Unceta M, Sánchez-Pedreño FO, Molero P, de Asúa DR. Takotsubo cardiomyopathy secondary to electroconvulsive therapy in a young adult with Down syndrome regression disorder. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2024; 196:e32078. [PMID: 38041246 DOI: 10.1002/ajmg.c.32078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/16/2023] [Accepted: 11/18/2023] [Indexed: 12/03/2023]
Abstract
We report the case of an 18-year-old woman with Down syndrome (DS) who developed Takotsubo cardiomyopathy (TSC) immediately after the administration of electroconvulsive therapy (ECT), a treatment prescribed for Down syndrome regression disorder resistant to oral psychotropic drugs. TSC is a nonischemic cardiomyopathy related to psychological or physical stress, which has been described as a rare complication of ECT (Kinoshita et al., 2023, Journal of Electroconvulsive Therapy, 39, 185-192). The clinical description of the case is accompanied by a discussion of the peculiarities of the autonomic nervous system in DS.
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Affiliation(s)
- María Del Carmen Ortega
- Department of Psychiatry and Clinical Psychology, Clínica Universidad de Navarra, Madrid, Spain
| | - José Pablo Bullard
- Department of Psychiatry and Clinical Psychology, Clínica Universidad de Navarra, Pamplona, Spain
| | - María Del Mar Unceta
- Department of Psychiatry and Clinical Psychology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Felipe Ortuño Sánchez-Pedreño
- Department of Psychiatry and Clinical Psychology, Clínica Universidad de Navarra, Pamplona, Spain
- Health Research Institute, Navarra (IdiSNA), Pamplona, Spain
| | - Patricio Molero
- Department of Psychiatry and Clinical Psychology, Clínica Universidad de Navarra, Pamplona, Spain
- Health Research Institute, Navarra (IdiSNA), Pamplona, Spain
| | - Diego Real de Asúa
- Department of Internal Medicine, Adult Down Syndrome Outpatient Clinic, Hospital Universitario de La Princesa, Madrid, Spain
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Kinoshita M, Kinoshita M, Takahashi R, Mutoh S, Kakuta N, Tanaka K. The Safety and Strategies for Reinitiating Electroconvulsive Therapy After ECT-Induced Takotsubo Cardiomyopathy: A Case Report and Systematic Review. J ECT 2023; 39:185-192. [PMID: 36897138 DOI: 10.1097/yct.0000000000000905] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
OBJECTIVES Takotsubo cardiomyopathy (TCM) is a life-threatening complication of electroconvulsive therapy (ECT). We report the case of a 66-year-old woman who was rechallenged with ECT after ECT-induced TCM. Moreover, we have made a systematic review to assess the safety of and strategies for reinitiating ECT after TCM. METHODS We searched for published reports on ECT-induced TCM since 1990 in MEDLINE (PubMed), Scopus, Cochrane Library, ICHUSHI, and CiNii Research. RESULTS A total of 24 ECT-induced TCM cases were identified. Patients who developed ECT-induced TCM were predominantly middle-aged and older women. There was no specific trend in anesthetic agents used. Seventeen (70.8%) cases developed TCM by the third session in the acute ECT course. Eight (33.3%) cases developed ECT-induced TCM despite the use of β-blockers. Ten (41.7%) cases developed cardiogenic shock or abnormal vital signs related to cardiogenic shock. All cases recovered from TCM. Eight (33.3%) cases tried to receive ECT retrial. The duration until ECT retrial was between 3 weeks and 9 months. The most common preventive measures during ECT retrial were related to β-blockers; however, the type, dose, and route of administration of β-blockers varied. In all cases, ECT could be reperformed without TCM recurrence. CONCLUSIONS Electroconvulsive therapy-induced TCM is more likely to cause cardiogenic shock than nonperioperative cases; nevertheless, it has good prognosis. Cautious reinitiation of ECT after TCM recovery is possible. Further studies are required to determine preventive measures for ECT-induced TCM.
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Affiliation(s)
- Michiko Kinoshita
- From the Department of Anesthesiology, Tokushima University Hospital, Tokushima-shi, Tokushima, Japan
| | - Makoto Kinoshita
- Department of Psychiatry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima-shi, Tokushima, Japan
| | - Rikako Takahashi
- From the Department of Anesthesiology, Tokushima University Hospital, Tokushima-shi, Tokushima, Japan
| | - Sarara Mutoh
- From the Department of Anesthesiology, Tokushima University Hospital, Tokushima-shi, Tokushima, Japan
| | - Nami Kakuta
- From the Department of Anesthesiology, Tokushima University Hospital, Tokushima-shi, Tokushima, Japan
| | - Katsuya Tanaka
- From the Department of Anesthesiology, Tokushima University Hospital, Tokushima-shi, Tokushima, Japan
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Barmore W, Patel H, Harrell S, Garcia D, Calkins Jr JB. Takotsubo cardiomyopathy: A comprehensive review. World J Cardiol 2022; 14:355-362. [PMID: 35979181 PMCID: PMC9258224 DOI: 10.4330/wjc.v14.i6.355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/24/2022] [Accepted: 05/23/2022] [Indexed: 02/06/2023] Open
Abstract
Takotsubo cardiomyopathy (TCM), also known as stress cardiomyopathy, occurs in the setting of catecholamine surge from an acute stressor. This cardiomyopathy mimics acute myocardial infarction in the absence of coronary disease. The classic feature of TCM is regional wall motion abnormalities with characteristic ballooning of the left ventricle. The etiology of the stressor is often physical or emotional stress, however iatrogenic causes of TCM have been reported in the literature. In our review, we discuss medications, primarily the exogenous administration of catecholamines, and a wide array of procedures with subsequent development of iatrogenic cardiomyopathy. TCM is unique in that it is transient and has favorable outcomes in most individuals. Classically, beta-blockers and ACE-inhibitors have been prescribed in individuals with cardiomyopathy; however, unique to TCM, no specific treatment is required other than temporary supportive measures as this process is transient. Additionally, no improvement in mortality or recurrence have been reported in patients on these drugs. The aim of this review is to elucidate on the iatrogenic causes of TCM, allowing for prompt recognition and management by clinicians.
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Affiliation(s)
- Walker Barmore
- Department of Internal Medicine, Augusta University Medical Center, Augusta, GA 30912, United States
| | - Himax Patel
- Department of Internal Medicine, Augusta University Medical Center, Augusta, GA 30912, United States
| | - Sean Harrell
- Department of Cardiovascular Medicine, Augusta University Medical Center, Augusta, GA 30912, United States
| | - Daniel Garcia
- Department of Internal Medicine, Augusta University Medical Center, Augusta, GA 30912, United States
| | - Joe B Calkins Jr
- Department of Cardiovascular Medicine, Augusta University Medical Center, Augusta, GA 30912, United States
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Looi JL, Chan C, Bridgman P, Kerr AJ. Takotsubo Syndrome in New Zealand: Current Knowledge and Future Challenges. Intern Med J 2022; 52:1863-1876. [PMID: 35289058 DOI: 10.1111/imj.15749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/12/2022] [Accepted: 03/04/2022] [Indexed: 11/28/2022]
Abstract
Takotsubo syndrome (TS), also known as apical ballooning syndrome is a transient stress-related cardiomyopathy characterised by acute but reversible left ventricular dysfunction. The condition tends to occur in postmenopausal women after a stressful event. At presentation TS typically mimics acute myocardial infarction (MI) and the incidence of TS has been increasing worldwide. This is likely a consequence of an improved awareness of the existence of this syndrome and easier access to early echocardiography and coronary angiography. However, its aetiology remains poorly understood and it is probably still underdiagnosed. Similar to other countries. TS is being increasingly recognised in New Zealand. In this review, we discuss the demographics, clinical features and outcomes of patients with TS in New Zealand. Doing so informs us not only of the pattern of disease in New Zealand but it also provides insights into the condition itself. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Jen-Li Looi
- Department of Cardiology, Middlemore Hospital, Private Bag 933111, Otahuhu, Auckland, New Zealand
| | - Christina Chan
- Department of Cardiology, Christchurch Hospital, Riccarton Avenue, Private Bag 4710, Christchurch, New Zealand
| | - Paul Bridgman
- Department of Cardiology, Christchurch Hospital, Riccarton Avenue, Private Bag 4710, Christchurch, New Zealand
| | - Andrew J Kerr
- Department of Cardiology, Middlemore Hospital, Private Bag 933111, Otahuhu, Auckland, New Zealand
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Hermida AP, Mohsin M, Marques Pinheiro AP, McCord E, Lisko JC, Head LW. The Cardiovascular Side Effects of Electroconvulsive Therapy and Their Management. J ECT 2022; 38:2-9. [PMID: 34699395 DOI: 10.1097/yct.0000000000000802] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Electroconvulsive therapy (ECT) remains stigmatized in the broader medical community because of misunderstandings about treatment procedures, mortality rates, and cardiovascular complications. Electroconvulsive therapy causes periprocedural hemodynamic variability because of the surges in parasympathetic and sympathetic nervous systems after the administration of the electrical charge. Patients experience an increase in cardiac workload, which is potentially dangerous for patients with preexisting heart disease. Several findings suggest that cardiac complications occur most frequently in patients with underlying cardiovascular disease. We describe the cardiovascular complications that may result from ECT treatment and offer insight on how to mitigate these concerns if they occur. PubMed was queried using terms "electroconvulsive therapy" and "cardiovascular adverse effects." A table is provided with the common cardiovascular side effects of ECT and the most recent evidence-based treatment strategies to manage them. Generally, ECT is a safe procedure in which complications are minor and manageable. Most major complications caused by ECT are related to the cardiovascular system; however, with an appropriate pre-ECT evaluation and a comprehensive multidisciplinary team approach, the cardiovascular complications can be well managed and minimized. Providing proper cardiac clearance can prevent cardiac complications and provide timely care to treatment-resistant populations who are at risk for excessive morbidity and suicide.
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Affiliation(s)
- Adriana P Hermida
- From the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Mamoona Mohsin
- Department of Psychiatry and Behavioral Medicine, Charleston Area Medical Center/West Virginia University, Charleston, West Virginia
| | - Ana P Marques Pinheiro
- From the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Elizabeth McCord
- From the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - John C Lisko
- Division of Cardiology, Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA
| | - Lyndsay W Head
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA
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Waheed TA, Nasir U, Aziz A, Chaudhary H, Donato A. Takotsubo syndrome associated with cardioversion: a systematic review. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2022. [DOI: 10.1186/s42444-021-00055-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Direct current cardioversion is a well-established and safe procedure to restore normal sinus rhythm for atrial and ventricular arrhythmias. Takotsubo syndrome has been rarely described with cardioversion. We reviewed the literature for descriptions of Takotsubo syndrome associated with the stress of cardioversion, to better understand its risks.
Methods
We queried MEDLINE, EMBASE, Google Scholar and Cochrane for cases of Takotsubo syndrome secondary to synchronized cardioversion as defined by Mayo Clinic Diagnostic Criteria.
Results
We identified 11 cases of cardioversion-associated Takotsubo syndrome. Average age was 76 years (range: 61–87 years) and most (10 out of 11, 91%) were female. Diagnosis was made soon after cardioversion (median: 10 h, range: 0–48 h). Only 2 of 11 had ST elevations noted, while apical ballooning was noted in all cases. Pulmonary edema developed in 6 and cardiogenic shock developed in 5 patients. The median recovery time was 7 days (range: 3–11).
Conclusions
Cardioversion-associated TS has an overall favorable outcome with complete recovery in most cases. A higher risk of this complication may exist for elderly females undergoing synchronized cardioversion.
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Kinno R, Ono K. Takotsubo Syndrome: Optimizing Care with a Multidisciplinary Approach. J Multidiscip Healthc 2021; 14:2487-2499. [PMID: 34531661 PMCID: PMC8439972 DOI: 10.2147/jmdh.s283667] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/23/2021] [Indexed: 12/19/2022] Open
Abstract
Symptoms of takotsubo syndrome (TTS) include acute and transient regional systolic dysfunction of the left ventricle, as well as a variety of wall-motion abnormalities. The clinical features of TTS, including initial symptoms, cardiac biomarkers, and electrocardiogram (ECG) changes, are similar to those of acute coronary syndrome, with the exception that TTS patients typically have no obstructive coronary artery disease. TTS primarily affects elderly women, and emotional or physical stress is a common cause of the disease. Exaggerated sympathetic stimulation associated with dysfunction of the limbic system has also been reported to be related to TTS occurrence. Cancer also induces emotional and physical stress. Therefore, optimization of TTS care should involve cardiac, neurological, psychiatric, and oncological approaches. The first step in optimizing TTS care is to diagnose it by cardiac means. Multimodality imaging, including ECG, echocardiogram, angiography, ventriculography, and cardiac magnetic resonance imaging, is indispensable for diagnosis, therapy management, and the evaluation of prognosis in the acute and chronic phases of TTS. The current cardiac approach during the acute phase is primarily supportive, with the goal of preventing life-threatening complications. As central nervous system diseases frequently trigger TTS, a neurological approach is also required. Appropriate psychiatric medication may reduce the risk of TTS recurrence, as not only psychiatric disorders themselves but also psychiatric medications can be the trigger for TTS. Several conditions are associated with TTS, including the novel coronavirus disease 2019. We present current knowledge of TTS in this review and describe how to optimize TTS care through a multidisciplinary approach.
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Affiliation(s)
- Ryuta Kinno
- Division of Neurology, Department of Internal Medicine, Showa University Northern Yokohama Hospital, Yokohama City, Kanagawa, 224-8503, Japan
| | - Kenjiro Ono
- Division of Neurology, Department of Medicine, Showa University School of Medicine, Tokyo, 142-8555, Japan
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Bansal S, Surve RM, Dayananda R. Challenges during Electroconvulsive Therapy—A Review. JOURNAL OF NEUROANAESTHESIOLOGY AND CRITICAL CARE 2021. [DOI: 10.1055/s-0041-1731627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
AbstractElectroconvulsive therapy (ECT) is one of the most successful treatment techniques employed in psychiatric practice. ECT is usually administered as a last resort to a patient who fails to respond to medical management or on an urgent basis as a life-saving procedure when immediate response is desired. It is performed under general anesthesia and is often associated with autonomic changes. All attempts should be made to minimize the resulting hemodynamic disturbances in all the patients using various pharmacological methods. Anesthesiologists providing anesthesia for ECT frequently encounter patients with diverse risk factors. Concurrent cardiovascular, neurological, respiratory, and endocrine disorders may require modification of anesthetic technique. It is ideal to optimize patients before ECT. In this review, the authors discuss the optimization, management, and modification of anesthesia care for patients with various cardiac, neurological, respiratory, and endocrine disorders presenting for ECT to improve the safety of the procedure. It is not infrequent that an anesthesiologist also plays an important role in inducing a seizure. Proconvulsants such as caffeine, adjuvants like opioids, hyperventilation, and appropriate choice of anesthetic agent for induction such as etomidate or ketamine can help. The use of BIS monitoring to guide the timing of electric stimulation is also elaborated in this review.
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Affiliation(s)
- Sonia Bansal
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Rohini M. Surve
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Rajeev Dayananda
- Department of Anaesthesia, BGS Gleneagles Global Hospitals, Kengeri, Bengaluru, Karnataka, India
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Prokudina ES, Kurbatov BK, Maslov LN. [Clinical Manifestation of Stressful Cardiomyopathy (Takotsubo Syndrome) and the Problem of Differential Diagnosis with Acute Myocardial Infarction]. ACTA ACUST UNITED AC 2020; 60:777. [PMID: 33487160 DOI: 10.18087/cardio.2020.11.n777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 12/28/2019] [Accepted: 01/09/2020] [Indexed: 11/18/2022]
Abstract
The presented data show that tacotsubo syndrome (TS) is characterized by the absence of coronary artery obstruction, cardiac contractile dysfunction, apical ballooning, and heart failure, and in some patients, ST-segment elevation and prolongation of the QTc interval. Every tenth patient with TS develops ventricular arrhythmias. Most of TS patients have elevated markers of necrosis (troponin I, troponin Т, and creatine kinase МВ (CK-МВ), which are considerably lower than in patients with acute myocardial infarction (AMI) with ST-segment elevation. The level of N-terminal pro-B-type natriuretic peptide (NT-proBNP), in contrast, is considerably higher in patients with TS than with AMI. Differential diagnosis of TS and AMI should be based on a multifaceted approach using coronary angiography, echocardiography, analysis of ECG, magnetic resonance imaging, single-photon emission computed tomography, and measurement of troponins, CK-MB, and NT-proBNP.
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Affiliation(s)
- E S Prokudina
- Cardiology Research Institute, Tomsk National Research Medical Center, Tomsk, Russia
| | - B K Kurbatov
- Cardiology Research Institute, Tomsk National Research Medical Center, Tomsk, Russia
| | - L N Maslov
- Cardiology Research Institute, Tomsk National Research Medical Center, Tomsk, Russia
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10
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Conte J, Yoo MJ, Larson NP. Seizure-Associated Takotsubo Cardiomyopathy. Cureus 2020; 12:e10599. [PMID: 33110734 PMCID: PMC7581222 DOI: 10.7759/cureus.10599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Takotsubo cardiomyopathy (TCOM) is a syndrome characterized by acute systolic dysfunction that can mimic acute coronary syndrome (ACS), usually incited by physical or emotional stress. However, acute neurological dysfunction, including seizures, has been recently described as an additional risk factor for the development of TCOM. This specific case report reviews the pathophysiology of TCOM and its management. We emphasize that providers should maintain a high index of suspicion for TCOM after acute neurologic dysfunction in patients with chest pain or hemodynamic instability, while also initiating proper investigation for ACS. Although classically thought of as a transient process, recent data show that both in-hospital and post-hospital morbidity and mortality related to this condition remain concerning.
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Affiliation(s)
- Juliette Conte
- Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, San Antonio, USA
| | - Michael J Yoo
- Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, San Antonio, USA
| | - Neil P Larson
- Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, San Antonio, USA
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11
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Cardiac stress after electroconvulsive therapy and spontaneous generalized convulsive seizures: A prospective echocardiographic and blood biomarker study. Epilepsy Behav 2019; 101:106565. [PMID: 31675603 DOI: 10.1016/j.yebeh.2019.106565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/11/2019] [Accepted: 09/11/2019] [Indexed: 11/21/2022]
Abstract
AIM Knowledge about cardiac stress related to seizures in electroconvulsive therapy (ECT) and spontaneously occurring generalized convulsive seizures (GCS) is limited. The aim of the present study was to analyze cardiac function and circulating markers of cardiac stress in the early postictal period after ECT and GCS. METHODS Patients undergoing ECT in the Department of Psychiatry, Psychotherapy and Psychosomatics and patients undergoing diagnostic video-EEG monitoring (VEM) in the Department of Neurology were prospectively enrolled between November 2017 and November 2018. Cardiac function was examined twice using transthoracic echocardiography within 60 min and >4 h after ECT or GCS. Established blood markers (troponin T high-sensitive, N-terminal pro brain natriuretic peptide) of cardiac stress or injury were collected within 30 min, 4 to 6 h, and 24 h after ECT or GCS. In the ECT group, the troponin T values were also correlated with periprocedural heart rate and blood pressure values. Because of organizational or technical reasons, the measurement was not performed in all patients. RESULTS Twenty patients undergoing ECT and 6 patients with epilepsy with a GCS during VEM were included. Postictal echocardiography showed no wall motion disorders and no change in left ventricular and right ventricular functions. Four of 17 patients displayed a transient increase in high-sensitive cardiac troponin T 4-6 h after the seizure (3 patients with ECT-induced seizure). None of these 4 patients had signs of an acute cardiac event, and periprocedural blood pressure or heart rate peaks during ECT did not significantly differ in patients with and without troponin T elevation. CONCLUSIONS Signs of mild cardiac stress can occur in some patients following ECT or GCS without clinical complications, probably related to excessive catecholamine release during the seizure.
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Zaghlol R, Hritani R, O'Donoghue S. Shock begets shock: A case of direct current cardioversion-induced takotsubo cardiomyopathy. HeartRhythm Case Rep 2019; 5:310-313. [PMID: 31285987 PMCID: PMC6587052 DOI: 10.1016/j.hrcr.2019.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Raja Zaghlol
- Division of Internal Medicine, MedStar Georgetown University Hospital/Washington Hospital Center, Washington, DC
| | - Rama Hritani
- Division of Internal Medicine, MedStar Georgetown University Hospital/Washington Hospital Center, Washington, DC
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Clifford K, Chaudhry W, Muscat S, Connors C, Whitesell D. Reinitiation of Electroconvulsive Therapy 4 Weeks After the Diagnosis of ECT-Induced Takotsubo Cardiomyopathy. PSYCHOSOMATICS 2019; 60:93-96. [PMID: 30119839 DOI: 10.1016/j.psym.2018.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 05/20/2018] [Accepted: 05/22/2018] [Indexed: 06/08/2023]
Affiliation(s)
| | - Waseem Chaudhry
- Department of Cardiology, Maine Medical Center, Portland, ME
| | - Sarah Muscat
- Department of Psychiatry, Maine Medical Center, Portland, ME
| | | | - Dena Whitesell
- Department of Psychiatry, Maine Medical Center, Portland, ME
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Sancassiani F, Carta MG, Montisci R, Preti A, Machado S, Moro MF, Marchetti MF, Meloni L. Takotsubo Syndrome is Associated with Mood Disorders and Antidepressants Use, not with Anxiety and Impairment of Quality of Life Due to the Psychiatric Disorder. Clin Pract Epidemiol Ment Health 2018; 14:26-32. [PMID: 29541148 PMCID: PMC5838620 DOI: 10.2174/1745017901814010026] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 01/14/2018] [Accepted: 02/06/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND The aim was to study the association between mood and anxiety disorders and the Tako-Tsubo Syndrome (TTS) and to determine the role of antidepressants and the impairment of quality of life due the comorbid psychiatric disorder. METHODS Case-control study: 19 consecutive patients (17 female) with TTS compared to 76 controls without TTS, were randomly selected from the database of a nationwide epidemiological study after matching (gender, age and residence) by controls. Psychiatric diagnoses were carried out according to the ICD-10 using semi-structured interview tools (ANTAS-SCID) administered by clinical staff. Quality of Life (Qol) was assessed by means of SF-12. RESULTS Only Major Depressive Disorders (MDD) showed higher frequencies in cases with statistical significance difference (p=0.014) as well as at least one Mood Disorder Diagnosis [MDD or BD] (p=0.002). The lifetime prevalence of at least one anxiety disorder with no comorbid mood disorder did not show a higher frequency in cases (p=0.57).The score at SF-12 in the TTS group was similar to those of controls (p=0.71)In the TTS group, the score at SF-12 in people with one mood or anxiety diagnosis (N=7) was similar to those without mood or anxiety diagnosis (p=0.75). The use of antidepressants was higher in TTS group (15.79% vs 1.31%; p=0.030). CONCLUSION The study shows an association between TTS with depressive disorders and antidepressants use and does not confirm the association with anxiety syndromes. The study suggests the need to investigate the possible interactions between antidepressants use and mood disorders in studies with appropriate design and sample size.
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Affiliation(s)
- F. Sancassiani
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Mauro G. Carta
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Roberta Montisci
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Antonio Preti
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Sergio Machado
- Laboratory of Panic and Respiration, Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
- Physical Activity Neuroscience, Physical Activity Sciences Postgraduate Program - Salgado de Oliveira University, Niterói, Brazil
| | - Maria F. Moro
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Maria F. Marchetti
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Luigi Meloni
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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15
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Nayeri A, Rafla-Yuan E, Krishnan S, Ziaeian B, Cadeiras M, McPherson JA, Wells QS. Psychiatric Illness in Takotsubo (Stress) Cardiomyopathy: A Review. PSYCHOSOMATICS 2018; 59:220-226. [PMID: 29544664 PMCID: PMC7652383 DOI: 10.1016/j.psym.2018.01.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 01/26/2018] [Accepted: 01/29/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Takotsubo cardiomyopathy (TC), also known as stress-induced cardiomyopathy, has been increasingly described in relation to psychiatric illness. METHODS We performed a literature review to identify the key findings related to psychiatric illness in TC that may be relevant to the practice of mental health and other health care providers. RESULTS The association of psychiatric illness with TC in addition to the spectrum of psychiatric illness found in TC, the role of exacerbation or treatment of psychiatric illness in triggering TC, different modes of presentation, prognostic implications, and long-term management of psychiatric illness in TC are discussed. Additionally, we review the limitations of the pre-existing literature and suggest areas of future research. CONCLUSIONS There is a strong association between pre-existing psychiatric illness, particularly anxiety and mood spectrum disorders, and TC. Acute exacerbation of psychiatric illness, rapid uptitration or overdose of certain psychotropic agents, and electroconvulsive therapy may trigger TC. Further studies are needed to better evaluate the prognostic significance and long-term management of psychiatric illness in TC.
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Affiliation(s)
- Arash Nayeri
- Department of Medicine, University of California, Los Angeles, CA.
| | - Eric Rafla-Yuan
- Department of Psychiatry, University of California, San Diego, CA
| | | | - Boback Ziaeian
- Department of Medicine, University of California, Los Angeles, CA
| | - Martin Cadeiras
- Department of Medicine, University of California, Los Angeles, CA
| | - John A McPherson
- Department of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Quinn S Wells
- Department of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN
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Lafferty CJ, Lafferty KM, Bhat T, Olson PC, Atoot A, Daneshvar F, McCord DA. Takotsubo Cardiomyopathy Precipitated by Tapering of Anxiolytic Medication: A Case Report. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2017; 11:1179546817746643. [PMID: 29270038 PMCID: PMC5731616 DOI: 10.1177/1179546817746643] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 11/07/2017] [Indexed: 11/29/2022]
Abstract
Takotsubo cardiomyopathy is a transient apical ballooning of the left ventricle typically with electrocardiographic changes and enzyme release without evidence of obstructive coronary artery disease. It typically occurs in postmenopausal women and may have a predilection for patients with anxiety disorders. The following is a case in which we believe takotsubo cardiomyopathy was induced by the tapering of antianxiety medications. We feel that health care professionals should be aware of this possibility in such a patient population especially when they have demonstrated cardiovascular symptomatology.
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Affiliation(s)
- Christopher J Lafferty
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, New York University Langone Medical Center, New York, NY, USA
| | - Kristen M Lafferty
- College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Tariq Bhat
- Department of Cardiology, Staten Island University Hospital, Northwell Health, Staten Island, NY, USA
| | - Peter C Olson
- Department of Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY, USA
| | - Adam Atoot
- Department of Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY, USA
| | - Farshid Daneshvar
- Department of Cardiology, Staten Island University Hospital, Northwell Health, Staten Island, NY, USA
| | - Donald A McCord
- Department of Cardiology, Staten Island University Hospital, Northwell Health, Staten Island, NY, USA
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17
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Pre-existing Psychiatric Illness is Associated With Increased Risk of Recurrent Takotsubo Cardiomyopathy. PSYCHOSOMATICS 2017; 58:527-532. [PMID: 28602445 DOI: 10.1016/j.psym.2017.04.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 04/17/2017] [Accepted: 04/18/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND The increased prevalence of psychiatric illness among patients with takotsubo cardiomyopathy (TC) has been previously described. OBJECTIVES We sought to assess the effect of pre-existing psychiatric illness on clinical outcomes following the diagnosis of TC. METHODS Adults diagnosed with TC at Vanderbilt University Medical Center between 1999 and 2015 were included in the study. Medical records were retrospectively reviewed to identify any pre-existing mood, anxiety, or schizophrenia-spectrum illness before TC presentation. Multivariable logistic regression was used to test for independent association of pre-existing psychiatric illness with 30-day mortality and recurrent TC; Cox proportional hazard analysis was used to evaluate for association with long-term mortality. RESULTS Among 306 patients diagnosed with TC during the study period, 114 (37%) had a pre-existing psychiatric illness. In all, 43 (14%) and 88 (29%) patients died within 30 days of index diagnosis and as of last medical record review, respectively. Of the 269 who survived their index hospitalization, 19 (7%) had a confirmed recurrent episode of TC. In multivariable analyses, pre-existing psychiatric illness was not associated with increased 30-day (P = 0.320) or long-term (P = 0.621) mortality. Pre-existing psychiatric illness was associated with higher risk of recurrent TC (odds ratio = 7.44, 95% CI: 2.30-24.01, P < 0.001). CONCLUSIONS Pre-existing psychiatric illness was associated with an increased risk of recurrent TC. No significant association was noted between pre-existing psychiatric illness and survival.
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Abstract
Electroconvulsive therapy (ECT) is an effective treatment commonly used for depression and other major psychiatric disorders. We discuss potential adverse effects (AEs) associated with ECT and strategies for their prevention and management. Common acute AEs include headache, nausea, myalgia, and confusion; these are self-limiting and are managed symptomatically. Serious but uncommon AEs include cardiovascular, pulmonary, and cerebrovascular events; these may be minimized with screening for risk factors and by physiologic monitoring. Although most cognitive AEs of ECT are short-lasting, troublesome retrograde amnesia may rarely persist. Modifications of and improvements in treatment techniques minimize cognitive and other AEs.
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Affiliation(s)
- Chittaranjan Andrade
- Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore 560 029, India.
| | - Shyam Sundar Arumugham
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore 560 029, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore 560 029, India
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Takotsubo cardiomyopathy and its relevance to anesthesiology: a narrative review. Can J Anaesth 2016; 63:1059-74. [DOI: 10.1007/s12630-016-0680-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 04/21/2016] [Accepted: 06/02/2016] [Indexed: 12/14/2022] Open
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Pérez-Castellanos A, Atienza F, Bueno H, Sousa I, Fernández-Avilés F. Tako-tsubo cardiomyopathy triggered by multiple shocks in electrical storm. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 8:771-774. [DOI: 10.1177/2048872616640994] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Tako-tsubo cardiomyopathy (TTC) is a syndrome characterized by acute transient ventricular dysfunction in the absence of obstructive coronary artery disease and is predominantly associated with exposure to sudden emotional or physical stress. Patients with TTC may develop serious in-hospital complications, including ventricular arrhythmias. However, triggering of TTC after an electrical storm has not previously been described. We present two cases of TTC induced by multiple shocks in the setting of an electrical storm due to pharmacologically induced long QT syndrome.
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Affiliation(s)
- Alberto Pérez-Castellanos
- Cardiology Department, Hospital General Universitario Gregorio Marañón; Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense de Madrid, Facultad de Medicina. Madrid, Spain
| | - Felipe Atienza
- Cardiology Department, Hospital General Universitario Gregorio Marañón; Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense de Madrid, Facultad de Medicina. Madrid, Spain
| | - Héctor Bueno
- Cardiology Department, Hospital General Universitario Gregorio Marañón; Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense de Madrid, Facultad de Medicina. Madrid, Spain
| | - Iago Sousa
- Cardiology Department, Hospital General Universitario Gregorio Marañón; Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense de Madrid, Facultad de Medicina. Madrid, Spain
| | - Francisco Fernández-Avilés
- Cardiology Department, Hospital General Universitario Gregorio Marañón; Instituto de Investigación Sanitaria Gregorio Marañón. Universidad Complutense de Madrid, Facultad de Medicina. Madrid, Spain
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