This study examined the prevalence of major and minor depression in patients with acute coronary syndrome and their relation with heart rate and heart-rate variability, and clinical characteristics. The study group included 297 patients, 200 men and 97 women, between ages of 21 and 70 years (M age = 57.5 +/- 9.6), who were admitted to a coronary care unit with acute coronary syndrome and survived to discharge from the hospital. Major and minor depression were diagnosed using DSM-IV. There were 44.1% patients with acute coronary syndrome without depression, 29.3% with minor depression, and 26.6% with major depression. The prevalence of minor and major depression was more elevated in patients with non-ST-segment elevation myocardial infarction and unstable angina than in patients with ST-segment elevation myocardial infarction. Ventricular fibrillation and atrial fibrillation were more common in patients with major and minor depression than in patients without depression. The 24-hr. duration of heart-beat intervals and heart-rate variability were significantly lower in patients with major and minor depression than in patients without depression. This study implies that clinical depression was significantly comorbid with the acute coronary syndrome and was related to hypertension, diabetes mellitus, age, sex, type of acute coronary syndrome, left ventricular failure, higher heart rate, and lower heart-rate variability.

The patient was a 34-year-old woman presented to the emergency department with a chest pain. During the last two years she took replacement therapy with levothyroxine because of lymphocytic thyroiditis. The ECG upon admittance verifies tall T waves in the precordial leads and the subsequent ECG shows a negativation of the T wave in the precordial leads. In the patient's echocardiographic findings, dyskinesia of the apical anterior segment is found, in laboratory findings increased levels of cardioselective biomarkers are present. Afterwards, a coronary angiography is done and no significant stenosis was detected in any coronary arteries, and ventriculography showed hypokinesia anterior mid segments. Considering all this, the diagnosis of Takotsubo cardiomyopathy is set, iatrogenically caused by thyrotoxicosis in combination with the recent Caesarean section.

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