Case Report

"Tako-Tsubo" Cardiomyopathy and Duloxetine Use

Authors: Francesco Rotondi, MD, Fiore Manganelli, MD, FESC, Giannignazio Carbone, MD, Giovanni Stanco, MD

Abstract

We report the case of a 68-year-old woman in whom the use of duloxetine, a potent serotonin and norepinephrine reuptake inhibitor, was associated with "tako-tsubo" cardiomyopathy (TTC). Although several pathophysiological mechanisms for TTC have been proposed, available evidence suggests that an excess of catecholamines may play a major role. Our patient had a history of myocardial infarction with normal coronary arteries, probably the first manifestation of TTC. We speculate that duloxetine may have precipitated TTC by increasing plasma catecholamine concentration in a predisposed patient.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Jim MH, Chan AO, Tsui PT, et al. A new ECG criterion to identify takotsubo cardiomyopathy from anterior myocardial infarction: role of inferior leads. Heart Vessels 2009;24:124-130.
 
2. Wittstein IS, Thiemann DR, Lima JA, et al. Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med 2005;352:539-548.
 
3. Rotondi F, Manganelli F, Di Lorenzo E, et al. Tako-tsubo cardiomyopathy in a patient with pacemaker syndrome. Europace 2009;11:1712-1714.
 
4. Thase ME, Tran PV, Wiltse C, et al. Cardiovascular profile of duloxetine, a dual reuptake inhibitor of serotonin and norepinephrine. J Clin Psychopharmacol 2005;25:132-140.
 
5. Bergman BR, Reynolds HR, Skolnick AH, et al. A case of apical ballooning cardiomyopathy associated with duloxetine. Ann Intern Med 2008;149:218-219.
 
6. Li XQ, Andersson TB, Ahlström M, et al. Comparison of inhibitory effects of the proton pump-inhibiting drugs omeprazole, esomeprazole, lansoprazole, pantoprazole, and rabeprazole on human cytochrome P450 activities. Drug Metab Dispos 2004;32:821-827.
 
7. Pathak H, Esses J, Pathak S, et al. A unique case of recurrent takotsubo cardiomyopathy. South Med J 2010;103:805-806.