Zvonarev Valeriy
School of Behavioral Sciences, California Southern University, Costa Mesa, USA.
Cureus. 2019 Jul 19;11(7):e5177. doi: 10.7759/cureus.5177.
Takotsubo cardiomyopathy (TTC) is reversible stress-induced cardiomyopathy featuring symptoms of acute myocardial infarction without significant coronary artery abnormalities. TTC is frequently precipitated by stressful emotional events but it also has been reported as a result of substance withdrawal, non-cardiac events, and dangerous drug-to-drug interaction. The plasma levels of both epinephrine and norepinephrine were significantly elevated in TTC patients, suggesting that elevated catecholamine levels might be the main contributing factor. However, the mechanisms underlying susceptibility to development and recurrence are not completely understood. It has been suggested that even a therapeutic dose of antidepressant could be a cause of drug-induced tachycardia and TTC. Moreover, some cases have been reported in which the development of TTC was associated with the serotonin syndrome, neuroleptic malignant syndrome, and similar fatal consequences. The aim of this article is to explore the association between underlying psychiatric disorders and TTC and to determine the role of various psychotropic medications in the progression of stress-induced cardiomyopathy. This article also notes and discusses the current theories underlying the pathophysiology of TTC. This review suggests a serious side effect of antidepressants, and to avoid life-threatening cardiovascular events, such as TTC, for patients with affective and anxiety disorders, prior screening for cardiovascular conditions by ECG with close monitoring might be necessary.
应激性心肌病（TTC）是一种可逆的应激性心肌病，其特征为出现急性心肌梗死症状但无明显冠状动脉异常。TTC常由应激性情绪事件诱发，但也有报道称其可由药物戒断、非心脏事件及危险的药物相互作用导致。TTC患者的肾上腺素和去甲肾上腺素血浆水平均显著升高，提示儿茶酚胺水平升高可能是主要促成因素。然而，其发生发展及复发的易感性潜在机制尚未完全明确。有研究表明，即使是治疗剂量的抗抑郁药也可能是药物性心动过速和TTC的病因。此外，已有报道称某些病例中TTC的发生与血清素综合征、抗精神病药恶性综合征及类似的致命后果有关。本文旨在探讨潜在精神障碍与TTC之间的关联，并确定各种精神药物在应激性心肌病进展中的作用。本文还阐述并讨论了目前关于TTC病理生理学的理论。本综述提示抗抑郁药存在严重副作用，为避免危及生命的心血管事件，如TTC，对于患有情感障碍和焦虑症的患者，可能有必要通过心电图对心血管状况进行预先筛查并密切监测。
