Universität zu Köln

Kudling, Ralf, Schoels, Wolfgang Hartmut and Kuhn, Jens (2018). Tako-Tsubo Cardiomyopathy during a series of Electroconvulsive Therapy (ECT) applications: A case report, systematic literature research and discussion of specific risk factors. Forschritte Neurol. Psychiatr., 86 (11). S. 699 - 711. STUTTGART: GEORG THIEME VERLAG KG. ISSN 1439-3522

Full text not available from this repository.

Abstract

Background Tako-Tsubo Cardiomyopathy (TTC) is an acute, reversible disease of the myocardium. It seems to be caused by an excess of epinephrine, norepinephrine and dopamine. Psychological or physiological stress is considered as a risk factor. Several cases of Tako-Tsubo cardiomyopathy in the context of seizures and electroconvulsive therapy have been reported. Methods We describe the case of a 63-year-old patient who developed TTC during a second series of ECT applications with etomidate anaesthesia and continued antidepressant medication with tranylcypromine. Potential pathophysiological correlations are discussed on the basis of the available literature. Given the increased risk of TTC recurrence, the question on reinitiation of ECT treatment after remission of the heart disease is also addressed. Results At least in theory, depressive disorders, ECT applications with seizures, the application of the anaesthetic etomidate, as well as tranylcypromine treatment may all be causally related to the development of TTC. Etomidate is known to interfere with cortisol synthesis, resulting in sympathomimetic and pro-inflammatory effects. To date, 19 cases of TTC in conjunction with ECT applications have been published. As in our patient, ECT was reinitiated successfully without complications in eight of them. Discussion ECT-related TTC seems to be caused by multiple factors. Circumstantial evidence in our case as well as published data does not support the conclusion that a single risk factor can be held responsible for the development of TTC. Based on theoretical considerations and preliminary findings on a potential role of a relative cortisol deficit, future studies should be encouraged to provide relevant evidence. If careful risk-benefit considerations are done and specific precautions are taken, previous TTC does not exclude reinitiation of ECT.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Kudling, Ralf UNSPECIFIED UNSPECIFIED UNSPECIFIED Schoels, Wolfgang Hartmut UNSPECIFIED UNSPECIFIED UNSPECIFIED Kuhn, Jens UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-166445
DOI:	10.1055/a-0653-7063
Journal or Publication Title:	Forschritte Neurol. Psychiatr.
Volume:	86
Number:	11
Page Range:	S. 699 - 711
Date:	2018
Publisher:	GEORG THIEME VERLAG KG
Place of Publication:	STUTTGART
ISSN:	1439-3522
Language:	German
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language MONOAMINE-OXIDASE INHIBITORS; TAKOTSUBO-CARDIOMYOPATHY; ADRENOCORTICAL FUNCTION; REVERSIBLE CARDIOMYOPATHY; CATECHOLAMINE RESPONSES; PSYCHOLOGICAL STRESS; CARDIAC MYONECROSIS; SALIVARY CORTISOL; SEIZURE DURATION; MENTAL STRESS Multiple languages Clinical Neurology; Psychiatry Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/16644