Takotsubo cardiomyopathy and major depressive disorder

Zusammenfassung

Gegenstand und Ziel: Das Tako-Tsubo-Syndrom (TTS) ähnelt klinisch einem akuten Myokardinfarkt und ist häufig mit emotionalem oder physischem Stress assoziiert. Patienten mit TTS stellen sich daher häufig zuerst in einer psychiatrischen Klinik vor; dies kann die adäquate Diagnostik und Therapie verzögern, insbesondere wenn der Psychiater nicht mit TTS vertraut ist. Material und Methoden: Ein klinischer Fall eines TTS wird vorgestellt und diskutiert und das Krankheitsbild des TTS vorgestellt. Ergebnisse: Eine 43-jährige Patientin stellte sich notfallmäßig in unserer psychiatrischen Ambulanz vor. Unmittelbar vor der Vorstellung war es am Arbeitsplatz zu erheblicher Schikane der Patientin gekommen (Mobbing). Zum Vorstellungszeitpunkt beklagte die Patientin akute linksthorakale Schmerzen sowie seit einigen Wochen bestehend gedrückte Stimmung, verminderten Antrieb, Anhedonie, generalisierte Ängste und Schlafprobleme. Das Elektrokardiogramm (EKG) war unauffällig, das Serumtroponin jedoch deutlich erhöht. Die Patientin wurde daraufhin in die Abteilung für Kardiologie verlegt. Herzkatheter und Kardio-MRT zeigten eine apikale Ballonbildung (apical ballooning) und linksventrikuläre Dysfunktion, passend zu TTS. Schlussfolgerungen und klinische Relevanz: Bei Patienten mit akuter Psychopathologie und kardialen und/oder thorakalen Symptomen sollten ein EKG und eine Bestimmung des Serumtroponins durchgeführt werden.

Summary

Objective: Takotsubo cardiomyopathy (TCM) mimics myocardial infarction and is frequently associated with emotional or physical stress. Therefore, patients with TCM frequently primarily present at a psychiatric clinic; this may impede adequate diagnosis and therapy, particularly when psychiatrists are not familiar with TCM. Material and methods: A clinical case of TCM is presented and discussed and the disease TCM is elucidated. Results: A 43-year-old female patient presented as an emergency patient to our psychiatric outpatient facility. Immediately prior to the admission, the patient had experienced an event of severe work-related harassment (workplace bullying). On admission, she complained of acute left thoracic chest pain as well as depressed mood, low energy, anhedonia, generalized anxiety, and sleep difficulties, present for several weeks. The electrocardiogram was unremarkable; serum troponin levels, however, were markedly elevated. The patient was then transferred to the department of cardiology. Cardiac catheterization and MRI ruled out acute coronary syndrome and showed apical ballooning and left ventricular dysfunction, compatible with TCM. Conclusions and clinical relevance: Electrocardiography and measurement of serum troponin levels should be performed in patients with acute psychopathology accompanied by cardiac and/or thoracic symptoms.

Schlüsselwörter

Akute Belastungsreaktion - akutes Koronarsyndom - depressive Störung - Stress-Kardiomyopathie

Keywords

Acute stress disorder - acute coronary syndrome - major depressive disorder - stress-induced cardiomyopathy

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