Takotsubo Cardiomyopathy and Psychiatric Illness: Redefining the Relationship


  • Hannah Masoud 1. St. George’s University School of Medicine, Grenada




Physicians who encounter patients in the emergency department with chest pain, palpitations, or shortness of breath may often find it difficult to differentiate diagnosis of panic attacks from acute coronary syndrome or Takotsubo Cardiomyopathy. Redefining and understanding the pathophysiological relationship of psychiatric illness including anxiety, depression, or panic attacks and Takotsubo Cardiomyopathy may help clinicians implement a more effective and beneficial model of care for this affliction that is being found to be increasingly more common in today’s age.


Wong AK, Vernick WJ, Wiegers SE, Howell JA, Sinha AC. Preoperative Takotsubo cardiomyopathy identified in the operating room before induction of anesthesia. Anesth Analg 2010;110:712–5. DOI: 10.1213/ane.0b013e3181b48594.

Hessel II EA, London MJ. Takotsubo (stress) cardiomyopathy and the anesthesiologist: enough case reports. Let's try to answer some specific questions! Anesth Analg 2010;110:674–9. DOI: 10.1213/ANE.0b013e3181c9fa22.

Nguyen SB, Cevik C, Otahbachi M, Kumar A, Jenkins LA, Nugent K. Do comorbid psychiatric disorders contribute to the pathogenesis of tako-tsubo syndrome? A review of pathogenesis. Congest Heart Fail 2009;15:31–4. DOI: 10.1111/j.1751-7133.2008.00046.x.

Theibich A, Klarlund K, Taskiran M. Recurrent case of Takotsubo syndrome. Ugeskr Laeger 2009;171:2716–7.

Chandra PA, Golduber G, Chuprun D, Chandra AB. Tako-tsubo cardiomyopathy following electroconvulsive therapy. J Cardiovasc Med (Hagerstown) 2009;10:333–5. DOI: 10.2459/JCM.0b013e328324eb0d.

Schiano P, Barbou F, Lallali M, Hemery Y, Revel F, Monségu J. Mid-ventricular ballooning heart syndrome during drug withdrawal. Presse Med 2009;38:1374–7. DOI: 10.1016/j.lpm.2008.08.019.

Agarwal S, Lyon A, Nachev P, Everitt A. The nervous heart: a case report and discussion of an under-recognized clinical problem. QJM 2009;102:807–9. DOI: 10.1093/qjmed/hcp109.

Stewart S, Brown A. Time to get anxious about the broken hearted? Int J Cardiol 2010;145:216–7. DOI: 10.1016/j.ijcard.2009.10.055.

Ziegelstein RC. Depression and tako-tsubo cardiomyopathy. Am J Cardiol 2010;105:281–2. DOI: 10.1016/j.amjcard.2009.09.002.

Champ-Rigot L, Alexandre J, Grollier G, Milliez P. Atypical Tako-tsubo syndrome: a morphologic variant or a step towards recovery? Int J Cardiol 2011;146:256–8. DOI: 10.1016/j.ijcard.2010.10.068.

Del Pace S, Parodi G, Bellandi B, Zampini L, Venditti F, Ardito M, et al. Tuscany Registry of Tako-tsubo Cardiomyopathy. Anxiety trait in patients with stress- induced cardiomyopathy: a case-control study. Clin Res Cardiol 2011;100:523–9. DOI: 10.1007/s00392-010-0276-x.

Corrigan III FE, Kimmel MC, Jayaram G. Four cases of takotsubo cardiomyopathy linked with exacerbations of psychiatric illness. Innov Clin Neurosci 2011;8:50–3.

Compare A, Proietti R, Del Forno D, Vitelli A, Grieco A, Maresca L, et al. Vulnerable personality and Takotsubo cardiomyopathy consequent to emotional stressful events: a clinical case report. Monaldi Arch Chest Dis 2011;76:99–103.

Thapamagar SB, Pasha AG, Krishnamurthy M, Schiavone JA. Atypical presentation of the broken heart syndrome associated with chronic anxiety. J Nepal Health Res Counc 2012;10:69–72.

Singh A, Southwick F, Gumm E, Makar JS. Exploring takotsubo cardiomyopathy in an elderly patient with acute anxiety attack. W V Med J 2012;108:14–7.

Maldonado JR, Pajouhi P, Witteles R. Broken heart syndrome (Takotsubo cardiomyopathy) triggered by acute mania: a review and case report. Psychoso- matics 2013;54:74–9. DOI: 10.1016/j.psym.2012.03.009.

JE Madias. Forme fruste cases of Takotsubo syndrome: a hypothesis. Eur. J Intern. Med. 25(2014) e47. DOI: 10.1016/j.ejim.2014.01.002.

Y-Hassan, Shams. The causal link between the blood borne catecholamines and takotsubo syndrome: Too many flaws. Int J Cardio 2015; 189; 194-195. DOI: 10.1016/j.ijcard.2015.04.075.

Y-Hassan, S., Henareh, L. Plasma catecholamine levels in patients with takotsubo syndrome: implications for the pathogenesis of the disease. Int. J. Cardiol. 2014;181:35–38. DOI: 10.1016/j.ijcard.2014.11.149.

Goh AC, Wong S, Zaroff JG, Shafaee N, Lundstrom RJ. Comparing Anxiety and Depression in Patients With Takotsubo Stress Cardiomyopathy to Those With Acute Coronary Syndrome. J Cardiopulm Rehabil Prev. 2016 Mar-Apr;36(2):106-11. doi: 10.1097/HCR.0000000000000152.

Opolski G, Budnik M, Kochanowski J, Kowalik R, Piatkowski R, Kochman J. Four episodes of takotsubo cardiomyopathy in one patient. Int. J. Cardiol. 2016 Jan 15; 203:53-4. DOI: 10.1016/j.ijcard.2015.10.048.

Seraphim A, Paschou SA, Grapsa J, Nihoyannopoulos P. J Cardiovasc Ultrasound. 2016 Mar;24(1):1-6. DOI: 10.4250/jcu.2016.24.1.1.

Shewan LG, Coats AJS, Henein M. Requirements for ethical publishing in biomedical journals. International Cardiovascular Forum Journal 2015;2:2. DOI: 10.17987/icfj.v2i1.4.