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

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.

Takotsubo Syndrome and COVID-19: Associations and Implications

“…This condition, also referred to as stress-induced cardiomyopathy, is distinguished by acute segmental ventricular dysfunction in a non-coronary distribution. It commonly occurs in reaction to severe emotional or physical stress and can cause significant clinical problems 7 . Patients have presentations mimicking acute coronary syndrome, with symptoms such as shortness of breath, hypotension, and chest pain.…”

Role of Depression and Anxiety Disorders in Takotsubo Syndrome: The Psychiatric Side of Broken Heart

“…However, it is well known that brain neurons that mediate vasoconstriction innervate coronary microcirculation, supports the concept that regional myocardial stunning among patients with TTS may be of neurogenic origin [22]. By the time, numerous studies demonstrated increased sympathetic activity, and consequent catecholamine excess, in TTS patients [27,36]. The higher epinephrine levels stimulate the β2-adrenoceptor coupling switch from membranous Gs to Gi proteins, with a consequent negative inotropic effect.…”

“…Nevertheless, it should also be considered that the survey was submitted during the hospital stay, possibly being influenced by hospitalization-related anxiety. Another case-control study based on 19 patients with TTS and sex-, age-, and residence-matched controls has shown that only major depressive disorder (MDD) had a significantly higher prevalence in Takotsubo patients than controls [27]. The main limitations of the previous two above studies were the small sample size.…”

A 62-Year-Old Man with Acute Alcohol Withdrawal and Stress-Induced Cardiomyopathy

“…Alcohol withdrawal has been associated with excess catecholamines releases from increased adrenergic activity, which can have a cardiomyotoxic effect [ 13 ] and there is increasing evidence that excess catecholamines can be responsible for TC [ 10 ]. Agu et al in their case report suspected that TC in patients with delirium tremens, which is a severe form of alcohol withdrawal syndrome, is possibly secondary to the cardiomyotoxic effect of catecholamines or CNS-medicated coronary spasm [ 17 ].…”

“…The pathophysiology is complex and not well understood. However, there is increasing evidence that excess catecholamines may be responsible for TC [ 10 ].…”