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Ralf Kudling1, Wolfgang Hartmut Schoels2, Jens Kuhn3
1Ev. Klinikum Niederrhein, Klinik für Psychiatrie, Psychotherapie und Psychosomatik.
Fortschritte Der Neurologie-Psychiatrie
|January 18, 2019
Summary
Tako-Tsubo Cardiomyopathy (TTC) can occur during electroconvulsive therapy (ECT), potentially due to multiple factors including anesthesia and antidepressants. Previous TTC does not necessarily preclude future ECT if risks are carefully managed.
Area of Science:
- Cardiology
- Neurology
- Psychiatry
Background:
- Tako-Tsubo Cardiomyopathy (TTC) is an acute, reversible heart condition often linked to stress and elevated catecholamines.
- Several cases of TTC have been reported in patients undergoing electroconvulsive therapy (ECT).
Observation:
- A 63-year-old patient developed TTC during a second ECT series, utilizing etomidate anesthesia and tranylcypromine antidepressant medication.
- The patient's depressive disorder, ECT, etomidate, and tranylcypromine were considered potential contributing factors to TTC.
Findings:
- ECT-related TTC appears multifactorial, with etomidate potentially affecting cortisol synthesis and causing sympathomimetic effects.
- Published data and this case suggest that ECT can be safely reinitiated in 8 out of 19 patients after TTC remission.
Implications:
- Careful risk-benefit assessment and precautions may allow for reinitiation of ECT in patients with a history of TTC.
- Further research is needed to explore the role of relative cortisol deficit in ECT-induced TTC.