Psychiatric Illness in Takotsubo (Stress) Cardiomyopathy: A Review

Abstract

Background: Takotsubo cardiomyopathy (TC), also known as stress-induced cardiomyopathy, has been increasingly described in relation to psychiatric illness.

Methods: We performed a literature review to identify the key findings related to psychiatric illness in TC that may be relevant to the practice of mental health and other health care providers.

Results: The association of psychiatric illness with TC in addition to the spectrum of psychiatric illness found in TC, the role of exacerbation or treatment of psychiatric illness in triggering TC, different modes of presentation, prognostic implications, and long-term management of psychiatric illness in TC are discussed. Additionally, we review the limitations of the pre-existing literature and suggest areas of future research.

Conclusions: There is a strong association between pre-existing psychiatric illness, particularly anxiety and mood spectrum disorders, and TC. Acute exacerbation of psychiatric illness, rapid uptitration or overdose of certain psychotropic agents, and electroconvulsive therapy may trigger TC. Further studies are needed to better evaluate the prognostic significance and long-term management of psychiatric illness in TC.

Keywords: Takotsubo; anxiety; depression; psychiatric illness; stress cardiomyopathy.

FIGURE 1.

Spectrum of Pre-existing Psychiatric Illness in TC (Borrowed, With Permission, From the Original Source).

FIGURE 2.

Mode of TC Trigger. Percent of Cases Triggered By Physical vs Nonphysical (Including Emotional) Stressors Are Shown.