[Venlafaxine was suspected to have triggered life-threatening takotsubo syndrome]

We present a case of a patient who ingested excessive amounts of the antidepressant Venlafaxine, a Selective Serotonin-Norepinephrine Reuptake Inhibitor (SNRI). She developed cardiogenic shock with clinical and echocardiographic signs of takotsubo syndrome, TTS; a life-threatening condition characterized by a transient regional cardiac dysfunction not solely caused by coronary artery occlusion. The pathogenesis remains unclear but catecholamines play a key role. Venlafaxine increases plasma catecholamine levels and with high probability it was judged to be the trigger for our patient's serious state. Our case study included clinical and laboratory data, as well as a literature review on published cases of SNRI associated TTS. Most cases of TTS fortunately show spontaneous recovery of cardiac function with conservative management and supportive treatment. No evidence-based treatment recommendations exist, but traditional inotropic and vasoactive drugs are considered potentially harmful, which can be a dilemma for the treating clinician, when facing an acutely decompensated TTS patient.