Takotsubo cardiomyopathy following electroconvulsive therapy: an increasingly recognised phenomenon

Abstract

SUMMARYTreatment of patients with severe depressive illnesses requiring electroconvulsive therapy (ECT) is challenging. This is compounded by the presence of physical comorbidities and potential complications. We report the case of a patient, on long-term bisoprolol, who developed acute epigastric pain and dyspnoea shortly after receiving ECT for treatment-refractory depression. An ECG showed new-onset ischaemic changes and a troponin-I level was elevated at 12 h. A diagnosis of Takotsubo cardiomyopathy was reached following angiography, which demonstrated left ventricular hypokinesia in the absence of coronary artery disease. With supportive treatment the patient made a good recovery. This report highlights the risk of developing Takotsubo cardiomyopathy following ECT despite β-adrenergic receptor blockade, and adds to a growing number of cases reporting this complication. Clinicians involved in the care of patients undergoing ECT must be aware of this complication and should consider Takotsubo cardiomyopathy in patients who develop atypical chest pain after ECT. BACKGROUND

Left ventricular thrombus and Takotsubo cardiomyopathy in a patient receiving electroconvulsive therapy:Case report and literature review

“…To the best of our knowledge, the present case is the first to describe LV thrombus associated with TC in this setting, suggesting that prolongation of the apical dyskinesis provided a favourable environment for thrombus development. There have been 14 cases reported consistent with features of TC: nine described specifically as TC (3)(4)(5)(8)(9)(10)(11)13,14), four described as myocardial stunning but with features of TC (6,7,15), and one with TC and cardiogenic shock (12). All cases except one were in middle-age or elderly women, similar to our patient.…”

“…TC is characterized by ST segment elevation on ECG, angiographically normal coronary arteries and LV apical dyskinesis (which, to Japanese investigators who first described the syndrome, resembled an octopus net or 'tako-tsubo'). TC is a rare complication following ECT, with only a handful of reported cases in literature (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). To the best of our knowledge, the present case is the first to describe LV thrombus associated with TC in this setting, suggesting that prolongation of the apical dyskinesis provided a favourable environment for thrombus development.…”

“…Beta-blockers may attenuate the preconditions to the development of TC. However, of the 14 reported cases, three (21%) developed TC despite being treated with an oral beta-blocker (10,12,13). All of these patients were on a beta-blocker at home, which was continued though ECT sessions.…”

Takotsubo cardiomyopathy and its relevance to anesthesiology: a narrative review

“…193,194 Interestingly, in eight patients, the TTCM occurred after the patient had previously undergone ECT treatments uneventfully. Only one of the six patients who underwent subsequent ECT treatments had a recurrence of TTCM.…”

Takotsubo Syndrome is Associated with Mood Disorders and Antidepressants Use, not with Anxiety and Impairment of Quality of Life Due to the Psychiatric Disorder

“…An indisputable fact is the several cases of Tako-Tsubo Syndrome reported in the literarture induced as a consequence of convulsant antidepressant therapy in which the elevated levels of catecholamines subsequent to the convulsant antidepressant therapy may be implicated [6-9]. …”