Psychiatric Illness in Takotsubo (Stress) Cardiomyopathy: A Review

Nayeri, Arash; Rafla-Yuan, Eric; Krishnan, Srikanth; Ziaeian, Boback; Cadeiras, Martín; McPherson, John; Wells, Quinn S.

doi:10.1016/j.psym.2018.01.011

Cited by 38 publications

(30 citation statements)

References 31 publications

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“…Depression and anxiety have been associated not only with TTS (Nayeri et al, 2018), but also with elevated risk of developing other cardiac diseases (Janszky et al, 2007;Kendler et al, 2009;Gustad et al, 2014;Galli et al, 2017). A recent retrospective cohort study (Nayeri et al, 2018) found that preexisting psychopathologic disorders (anxiety, mood disorders, and schizophrenia) were associated with an increased risk of recurrent TTS, but not to survival. It is well recognized that the comorbidity of anxiety and depression is more the rule than the exception in many chronic disorders (Fava et al, 2012;Nayeri et al, 2017) including cardiac diseases (Bahremand et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

Traumatic Events, Personality and Psychopathology in Takotsubo Syndrome: A Systematic Review

2019

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Objective: Takotsubo syndrome (TTS) is a transient heart disease that has been historically related to the occurrence of psychological (emotional) factors ("broken heart" syndrome). We aimed to conduct a systematic review analyzing the role of psychological factors in TTS. Methods: All studies on TTS and psychological factors from January 1991 through April 2019 were scrutinized according to the Cochrane Collaboration and the PRISMA statements. Selected studies were additionally evaluated for the Risk of Bias according to the Newcastle-Ottawa Scale (NOS). Results: Fifteen case-control studies (by Mayo Clinic criteria) were finally selected. Most studies analyzed stressful life-events or trauma, although with conflicting findings, while a likely role of long-lasting psychological distress seemed to be a homogenous result. Among lifetime psychopathology, only anxiety appeared to have a significant role. Some studies outlined a likely role of personality, but findings are conflicting. Conclusion: Our findings do not lead to any definitive assumption on the specific role of psychological factors in TTS, also for scant strong methodology of the most part of the studies. More studies with stronger research methodology are needed to better characterize psychological elements in TTS.

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Section: Discussionmentioning

confidence: 99%

Traumatic Events, Personality and Psychopathology in Takotsubo Syndrome: A Systematic Review

2019

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“…The spasm is induced by a sudden catecholamine increase since patients with takotsubo cardiomyopathy have elevated catecholamine blood concentrations. Takotsubo cardiomyopathy was also strongly associated with mental illnesses (19). Although our patient did not undergo angiography, we find takotsubo cardiomyopathy a more likely diagnosis than ST-elevation myocardial infarction for several reasons.…”

Section: Discussionmentioning

confidence: 99%

“…There are three reports on the concomitant use of beta blockers in patients who develop takotsubo cardiomyopathy, similar to our case (5,7,12). Patients may be predisposed to develop takotsubo cardiomyopathy by conditions that raise baseline catecholamine level (17,19). Both caffeine and nicotine elevate catecholamine blood levels (25), and our patient’s caffeine and nicotine use could have precipitated a cardiovascular accident.…”

Section: Discussionmentioning

confidence: 99%

Takotsubo cardiomyopathy after the first electroconvulsive therapy regardless of adjuvant beta-blocker use: a case report and literature review

et al. 2018

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Takotsubo cardiomyopathy (TC) is a rare complication of electroconvulsive therapy (ECT), an effective and safe treatment for severe cases of depression and psychosis. There are reports on 16 patients who developed TC after ECT, and these were predominantly female patients treated with antidepressants for depressive disorder. We describe a case of a 40-year-old male patient, with a history of schizophrenia and heavy caffeine and nicotine use, treated for acute psychotic episode with haloperidol and clozapine. Propranolol was administered because of clozapine-induced tachycardia. After 8 weeks without therapeutic response, the patient was referred for standard ECT procedure, which included premedication and bifrontotemporal stimulation. Two hours later, the patient experienced gastric pain and had increased troponin and natriuretic peptide levels and ST-elevation. After inotrope and anticoagulant treatment and replacement of antipsychotics, the patient remained stable. Contrary to common opinion, previous adrenergic blockade in this patient did not prevent TC occurrence. TC pathophysiology remains unclear although it has been related to the burst of norepinephrine neurons. Psychosis has also been associated with catecholamine dysfunction, and excessive psychological stress with long-term norepinephrine dysfunction. Animal models have shown that ECT, clozapine, and nicotine and caffeine use could considerably increase catecholamine levels. Clinical understanding of rare cardiac ECT complications could improve early recognition of patients at risk for TC and ensure safe ECT protocols.

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“…Nevertheless, this result can be explained by looking at the greater prevalence of psychiatric diseases, primarily anxiety, in patients with TTS in this study. Moreover, to date, there have been no clear cases of SSRIs as triggers of TTS [44].…”

Section: Psychoactive Drugsmentioning

confidence: 99%

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

Oliveri¹,

Goud²,

Mohammed³

et al. 2020

Cureus

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Takotsubo syndrome (TTS), also called broken heart syndrome, is an acute and transient cardiac wall motion abnormality of the left ventricle. The patient prototype is a postmenopausal woman with myocardial infarction-like symptoms (angina pectoris, breathlessness, palpitations, etc.) who has experienced sudden emotional or physical stress. Although prognosis is generally considered relatively benign, both complications and recurrence rates are not insignificant. Pathophysiological mechanisms underlying TTS are not entirely understood, but the sympathetic system over-activity has a leading role. Moreover, since emotional stress frequently triggers TTS and since precedent diagnosis of psychiatric disorders sometimes coexists, the psychological response to stress could be another potential therapeutic target. Indeed, this article aims to explore the association between underlying depression and anxiety disorders and TTS, as well as to find ideal therapeutic options useful to treat and prevent TTS. Thus in our review, we considered case reports, case-control studies, and review articles from PubMed. Papers dealing with Takotsubo syndrome and anxiety disorder or depression were selected. We included papers published since 2010 and whose abstract was in English. We concluded that anxiety disorders, but not depression, are associated with a higher occurrence of TTS. There is a link between anxiety, TTS, and inflammation leading to increased sympathetic activity. Nevertheless, patients with pre-admission psychiatric disorders have a higher risk of recurrent TTS. Importantly, the use of selective serotonin reuptake inhibitors (SSRIs) could be a potential therapeutic aid in preventing TTS's recurrence in selected patients.

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Psychiatric Illness in Takotsubo (Stress) Cardiomyopathy: A Review

Cited by 38 publications

References 31 publications

Traumatic Events, Personality and Psychopathology in Takotsubo Syndrome: A Systematic Review

Traumatic Events, Personality and Psychopathology in Takotsubo Syndrome: A Systematic Review

Takotsubo cardiomyopathy after the first electroconvulsive therapy regardless of adjuvant beta-blocker use: a case report and literature review

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

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