Four cases of takotsubo cardiomyopathy linked with exacerbations of psychiatric illness

Objective. Takotsubo cardiomyopathy is a rare cardiac syndrome most often occurring in post-menopausal women after an acute episode of severe emotional or physical stress. Prior literature suggests a higher prevalence of anxiety and depression among patients with Takotsubo cardiomyopathy. We observed four cases of Takotsubo cardiomyopathy at one tertiary care center preceded by and concurrent with exacerbations of psychiatric illness rather than after acute episodes of stress. We examined each to further understand Takotsubo cardiomyopathy's pathogenesis and relationship to psychiatric illness. Methods. We retrospectively reviewed four consecutive cases of Takotsubo cardiomyopathy at one tertiary center from August 2009 to October 2009. The Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition, Text Revision criteria were used to diagnose psychiatric illness. Each patient was diagnosed with Takotsubo cardiomyopathy via cardiac catheterization. Results. Each woman (age range 53-67 years) was previously diagnosed with psychiatric illness. Psychiatric illnesses were as follows: Alzheimer's dementia with psychotic features, adjustment disorder, major depressive disorder, and bipolar affective disorder type 1. All four cases demonstrated exacerbations of their psychiatric illness just prior to and concurrent with their diagnosis of Takotsubo cardiomyopathy. They showed improved left ventricular ejection fraction within 1 to 3 weeks after diagnosis with supportive care. Conclusions. Differing from the traditional cases of Takotsubo cardiomyopathy, which follow acute events of stress, our four cases indicate exacerbations of underlying psychiatric illness can lead to Takotsubo cardiomyopathy. In addition to anxiety and depression, psychosis and mania may predispose an individual to Takotsubo cardiomyopathy. We suggest that cardiologists and psychiatrists be aware of this association and screen patients. We suggest further studies that may help better understand the connection between the heart and mind.