Takotsubo cardiomyopathy and acute manic attack

Abstract

Takotsubo cardiomyopathy predominantly occurs in women, with a high incidence in patients with psychiatric diseases. We present a 64-year-old white woman with an acute manic episode complicated by rhabdomyolysis and takotsubo cardiomyopathy.

Takotsubo Syndrome Associated with a New Onset Manic Episode: A case report

“…3 For example, an investigation by The International Takotsubo Registry showed that patients with TTS had significantly higher rates of depression and anxiety compared with controls, 1 while another study reported higher rates of major depressive disorders in TTS patients compared with controls but not anxiety disorders 4 and another study showed higher rates of anxiety but not depression compared with controls. 5 Previous studies have reported cases of TTS related to acute manic attacks [6][7][8] or to an underlying bipolar disorder. 9,10 The exact aetiology of TTS is still unknown, but one hypothesis is that psychiatric illness and chronic stress could activate the hypothalamic-pituitary-adrenal (HPA) axis, increasing release of catecholamines, 11 and subsequently causing TTS.…”

“…Previous studies have reported cases of TTS related to acute manic attacks 6–8 or to an underlying bipolar disorder. 9,10 The exact aetiology of TTS is still unknown, but one hypothesis is that psychiatric illness and chronic stress could activate the hypothalamic-pituitary-adrenal (HPA) axis, increasing release of catecholamines, 11 and subsequently causing TTS.…”

The authors respond

“…We would like to thank the authors of the letter for their interest in our paper. 1 Mental disorders are a major cause of morbidity, and patients with mental health disorders have a higher incidence of takotsubo cardiomyopathy (TC). We agree with the authors that our patient had a combination of both emotional and physical stressors.…”

“…However, nephrogenic systemic fibrosis and acute kidney injury due to primary excretion of gadolinium from the kidneys and various cardiac arrhythmias including QTc electrocardiographic prolongation and hypersensitivity reactions are occasionally encountered with use of such contrast mediums. 1…”

Takotsubo cardiomyopathy and its implications in the setting of acute manic attack

“…Over the past several years, takotsubo cardiomyopathy (TC) has been the focus of interest as a transient form of cardiomyopathy generally emerging in response to a variety of emotional and physical stressors associated with adrenergic discharge. 1,2 In their recently published elegant article, 1 Idris et al reported a unique case of TC due to an acute manic attack. However, we would like to make a few comments on potential implications of TC in this specific setting.…”