Corrigan Frank E, Kimmel Mary C, Jayaram Geetha
Dr. Corrigan is from the Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
Innov Clin Neurosci. 2011 Jul;8(7):50-3.
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.
目的。应激性心肌病是一种罕见的心脏综合征，最常发生于绝经后女性，常在严重情绪或身体应激的急性发作之后。既往文献表明，应激性心肌病患者中焦虑和抑郁的患病率较高。我们在一家三级医疗中心观察到4例应激性心肌病患者，其发病前及发病时伴有精神疾病加重，而非在应激急性发作之后。我们对每例患者进行检查，以进一步了解应激性心肌病的发病机制及其与精神疾病的关系。
方法。我们回顾性分析了2009年8月至2009年10月在一家三级中心连续收治的4例应激性心肌病患者。采用《精神障碍诊断与统计手册》第四版修订版标准诊断精神疾病。通过心脏导管检查对每例患者诊断为应激性心肌病。
结果。每位女性（年龄范围53 - 67岁）既往均被诊断患有精神疾病。精神疾病如下：伴有精神病性特征的阿尔茨海默病性痴呆、适应障碍、重度抑郁症和双相情感障碍1型。所有4例患者在诊断应激性心肌病之前及同时均表现出精神疾病加重。经支持治疗后，她们在诊断后1至3周内心室射血分数有所改善。
结论。与传统的应激性心肌病病例（发生于应激急性事件之后）不同，我们的4例病例表明，潜在精神疾病加重可导致应激性心肌病。除焦虑和抑郁外，精神病和躁狂可能使个体易患应激性心肌病。我们建议心脏病专家和精神科医生了解这种关联并对患者进行筛查。我们建议进行进一步研究，以更好地理解心脏与精神之间的联系。
