Izvorni znanstveni članak
https://doi.org/10.3325/cmj.2018.59.307
Takotsubo cardiomyopathy after the first electroconvulsive therapy regardless of adjuvant beta-blocker use: a case report and literature review
Sara Medved
; Department of Psychiatry University Hospital Centre Zagreb, Zagreb, Croatia
Zvonimir Ostojić
; University Clinic of Cardiovascular Diseases, University Hospital Centre Zagreb, Zagreb, Croatia
Hrvoje Jurin
; University Clinic of Cardiovascular Diseases, University Hospital Centre Zagreb, Zagreb, Croatia
Vesna Medved
; Department of Psychiatry University Hospital Centre Zagreb, Zagreb, Croatia
Sažetak
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.
Ključne riječi
Hrčak ID:
239725
URI
Datum izdavanja:
16.12.2018.
Posjeta: 618 *