Myocardial Stunning After Electroconvulsive Therapy in Patients With an Apparently Normal Heart

Go, Orson; Mukherjee, Ratnakar; Bhatta, Luna; Carhart, Robert; Villarreal, Daniel

doi:10.1097/yct.0b013e31817e1cbf

Cited by 11 publications

(14 citation statements)

References 38 publications

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“…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.…”

Section: Discussionsupporting

confidence: 81%

“…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.…”

Section: Discussionmentioning

confidence: 59%

“…The reported initial clinical presentation varied, some presented with only ECG changes and no cardiac symptoms (5,6,14,15) while others developed chest pain (3,4,(9)(10)(11) or shortness of breath or even cardiogenic shock (7,12). All patients recovered and no deaths were reported.…”

Section: Discussionmentioning

confidence: 99%

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

Agarwal¹,

Pothineni²,

Payne³

et al. 2015

Curr Res Cardiol

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SK Agarwal, NVK Pothineni, J Payne, S Vallurupalli, BF Uretsky. Left ventricular thrombus and Takotsubo cardiomyopathy in a patient receiving electroconvulsive therapy: Case report and literature review. Curr Res Cardiol 2015;2(4):202-204.Cardiovascular side effects after electroconvulsive therapy (ECT) are rare but can potentially lead to significant morbidity and mortality. The authors present a case involving a 67-year-old woman who developed Takotsubo cardiomyopathy (TC) with left ventricular (LV) thrombus eight days after her last ECT. She received six ECT treatments for active suicidal ideation after prophylaxis with oral metoprolol and intravenous esmolol and was discharged home. She presented to the emergency room with altered mental status, where an electrocardiogram revealed anterior ST segment elevation compatible with an ST segment elevation myocardial infarction. Emergent coronary angiogram was normal. Left ventriculogram showed characteristic apical dyskinesis compatible with TC. Echocardiogram revealed an apical LV thrombus. The patient was placed on anticoagulant therapy. Repeat echocardiogram eight weeks later showed normal LV function with resolution of thrombus. Physicians managing ECT patients should be aware of the possibility of TC with LV thrombus as a complication of this procedure. The authors review the medical literature and provide recommendations for peri-ECT management of patients with previous TC.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 59%

See 1 more Smart Citation

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

Agarwal¹,

Pothineni²,

Payne³

et al. 2015

Curr Res Cardiol

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“…Although there is eventual recovery, it can cause severe hemodynamic instability 94 . We found 5 reported cases of myocardial stunning after ECT, all of which occurred in women without prior known history of coronary artery disease 95–98 . Of these 5 patients, 3 presented with heart failure.…”

Section: Myocardial Stunningmentioning

confidence: 98%

The Cardiovascular Side Effects of Electroconvulsive Therapy and Their Management

Hermida

Mohsin

Pinheiro

et al. 2021

J ECT

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Electroconvulsive therapy (ECT) remains stigmatized in the broader medical community because of misunderstandings about treatment procedures, mortality rates, and cardiovascular complications. Electroconvulsive therapy causes periprocedural hemodynamic variability because of the surges in parasympathetic and sympathetic nervous systems after the administration of the electrical charge. Patients experience an increase in cardiac workload, which is potentially dangerous for patients with preexisting heart disease. Several findings suggest that cardiac complications occur most frequently in patients with underlying cardiovascular disease. We describe the cardiovascular complications that may result from ECT treatment and offer insight on how to mitigate these concerns if they occur. PubMed was queried using terms "electroconvulsive therapy" and "cardiovascular adverse effects." A table is provided with the common cardiovascular side effects of ECT and the most recent evidence-based treatment strategies to manage them. Generally, ECT is a safe procedure in which complications are minor and manageable. Most major complications caused by ECT are related to the cardiovascular system; however, with an appropriate pre-ECT evaluation and a comprehensive multidisciplinary team approach, the cardiovascular complications can be well managed and minimized. Providing proper cardiac clearance can prevent cardiac complications and provide timely care to treatment-resistant populations who are at risk for excessive morbidity and suicide.

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“…Manche Autoren vermuten daher weiterhin, dass es nach der elektrischen Stimulation und dem Eintreten der Spike-and-Wave-Aktivität zu einem erhöhten intracerebralen Blutfluss kommt, der wiederum zu einem erhöhten intrakraniellen Druck führt. Dies würde zu einer zentralen parasympathischen Entladung führen, die innerhalb von Sekunden von einer Aktivierung des Sympathikus gefolgt wird [39].…”

Section: Die Tako-tsubo-kardiomyopathieunclassified

Tako-Tsubo-Kardiomyopathie während einer EKT-Serie: Fallbericht, systematische Literaturrecherche und Diskussion spezifischer Risikofaktoren

Kudling

Schoels

Kuhn

2018

Fortschr Neurol Psychiatr

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Zusammenfassung Hintergrund Bei der Tako-Tsubo-Kardiomyopathie (TTK) handelt es sich um eine akute reversible Erkrankung des Herzmuskels. Sie wird ursächlich mit einem Überschuss an Adrenalin, Noradrenalin und Dopamin in Zusammenhang gebracht. Als bekannte Risikofaktoren gelten psychischer und physischer Stress. Es existieren Fallberichte über das Auftreten von TTK nach Krampfanfällen sowie EKT-Behandlungen. Methoden Es wird der Fall eines 63 Jahre alten Patienten vorgestellt, bei dem es im Verlauf einer zweiten EKT-Serie unter Etomidat-Narkose und laufender antidepressiver Medikation mit Tranylcypromin zu einer TTK kam. Mögliche pathophysiologische Zusammenhänge werden anhand der zur Verfügung stehenden Literatur diskutiert. In Anbetracht eines erhöhten Rezidivrisikos wird der Frage nachgegangen, ob die Wiederaufnahme der EKT-Behandlung nach Abklingen der TTK verantwortbar ist. Ergebnisse Depressive Störungen, EKT-Behandlungen mit konvulsiven Anfällen, der Einsatz von Etomidat als Narkotikum sowie eine Behandlung mit Tranylcypromin könnten eine theoretische Rolle als Risikofaktoren für die TTK spielen. Die durch Etomidat vermittelten Effekte könnten auf die substanzbedingte Störung der Kortisolsynthese und einer daraus resultierenden sympathomimetischen und pro-inflammatorischen Wirkung zurückgeführt werden. Es konnten 19 publizierte TTK-Fälle im Zusammenhang mit EKT gefunden werden. Einschließlich des hier vorgestellten Patienten wurde in 8 Fällen von einer erfolgreichen und komplikationslosen Wiederaufnahme der EKT-Behandlung berichtet. Diskussion Das Auftreten der TTK scheint letztlich multifaktoriell begründet zu sein. Die Konstellation unseres Falles sowie die analysierte medizinische Literatur erlauben keinen Rückschluss, dass einer der genannten Faktoren alleine für die Entstehung der TTK verantwortlich gemacht werden kann. Angesichts der theoretischen Überlegungen und Teilbefunde über die mögliche Rolle eines relativen Kortisol-Defizits für die TTK wären gezielte Untersuchungen wünschenswert. Die Wiederaufnahme der EKT-Behandlung nach einem TTK-Fall ist, unter Risikoabwägung und Berücksichtigung besonderer Vorsichtsmaßnahmen, nicht ausgeschlossen.

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Myocardial Stunning After Electroconvulsive Therapy in Patients With an Apparently Normal Heart

Cited by 11 publications

References 38 publications

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

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

The Cardiovascular Side Effects of Electroconvulsive Therapy and Their Management

Tako-Tsubo-Kardiomyopathie während einer EKT-Serie: Fallbericht, systematische Literaturrecherche und Diskussion spezifischer Risikofaktoren

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