“Broken Heart Syndrome” After Separation (From OxyContin)

Abstract

We describe a 61-year-old woman with "broken heart syndrome" (Takotsubo-like cardiomyopathy) after abrupt postsurgical withdrawal of OxyContin. Her medical history was remarkable for long-term opiold dependence associated with the treatment of multi-Joint degenerative osteoarthritis. The patient presented to the emergency department 1 day after discharge from the hospital following total knee arthroplasty revision with acute-onset dyspnea and mild chest pain. She had precordial ST-segment elevation characteristic of acute myocardial infarction and elevated cardiac biomarkers. Emergency coronary angiography revealed no major coronary atherosclerosis. However, the left ventricular ejection fraction was severely decreased (26%), and new regional wall motion abnormalities typical of broken heart syndrome were noted. In addition to resuming her opioid therapy, she was treated supportively with bilevel positive airway pressure, diuretic therapy, morphine, aspirin, metoprolol, enalaprilat, intravenous heparin, nitroglycerin infusion, and dopamine infusion. Ventricular systolic function recovered completely by the fourth hospital day. To our knowledge, broken heart syndrome after opioid withdrawal has not been reported previously in an adult. Our case illustrates the importance of continuing adequate opiate therapy perioperatively in the increasing number of opioid-dependent patients to prevent potentially life-threatening complications such as broken heart syndrome.

Takotsubo Cardiomyopathy: A Unique Cardiomyopathy With Variable Ventricular Morphology

“…Commonly reported precipitating stressors include being informed of the death of a loved one, social events such as public speaking or a surprise birthday party, and anxiety or pain related to a medical procedure (1)(2)(3)(4)(5)(6)9). Other situations that are less common, but still considered possible triggers of takotsubo cardiomyopathy, include cocaine use (13), opiate withdrawal (14), stress testing (15) (with dobutamine [16]), lightning strike (17), ergonovine injection (18), and thyrotoxicosis (19). A chronobiological pattern has also been reported by a multicenter Italian study, with increased frequency of presentation in the summer months and in the morning hours (20).…”

Takotsubo Syndrome: A Bayesian Approach to Interpreting Its Pathogenesis

“…1 When used to address rare medical conditions like Takotsubo syndrome, which is discussed in 3 articles in this issue of Mayo Clinic Proceedings, [2][3][4] the Bayesian theory suggests that rare or variant presentations of common diseases are more common than common presentations of rare diseases. 1 When used to address rare medical conditions like Takotsubo syndrome, which is discussed in 3 articles in this issue of Mayo Clinic Proceedings, [2][3][4] the Bayesian theory suggests that rare or variant presentations of common diseases are more common than common presentations of rare diseases.…”

Tapering Long-term Opioid Therapy in Chronic Noncancer Pain

“…69 A fast or ultrafast taper can be considered when inpatient taper is needed because of significant coexisting psychiatric or medical illness, such as SUD or unstable cardiac disease (recommendation GRADE C). 37,38 In the absence of validated protocols, empirical plans have been proposed (recommendation GRADE D). Plans often first reduce the dose of the medication to the smallest commonly available unit dosage and then increase the amount of time between doses (eg, in a regimen of 60 mg of extended-release morphine every 8 hours, first decreasing to 15 mg of extended-release morphine every 8 hours, then increasing the interval between the doses).…”

“…Case reports of complicated withdrawal requiring acute care, typically following abrupt cessation of opioids in the context of SUD or CNCP, include organic delusional syndromes 36 or stress cardiomyopathy. 37,38 Increased Pain. Many patients fear that their pain will increase during an opioid taper.…”