Broken heart syndrome: Tako Tsubo cardiomyopathy associated with an overdose of the serotonin–norepinephrine reuptake inhibitor Venlafaxine

Abstract 

Objective

To describe a case of Tako Tsubo cardiomyopathy [TTC] in a patient after an overdose of the serotonin–norepinephrine reuptake inhibitor [SNRI] Venlafaxine.

Methods

We present a case study including clinical and laboratory data. Current relevant literature is reviewed and summarized in regard to Tako Tsubo syndrome and SNRI.

Results

A 43year-old woman was admitted with acute angina pectoris after accidentally taking an overdose on Venlafaxine in order to treat major depression. Because of the ECG-T-wave-inversions in the precordial leads, the slightly increased Troponin/Creatine kinase levels and the apical systolic dysfunction of the left ventricle in echocardiogram a cardiac catheterization was performed. Coronary artery disease could be excluded by coronary angiography. The followed laevocardiography and cardiac MRI scan showed apical akinesis and basal hypercontractibility typical for apical ballooning (Tako Tsubo cardiomyopathy). Urine analysis revealed elevated normetanephrine level potentially caused by Venlafaxine. Six weeks after the first admission the echocardiogram showed a complete recovery to normal left ventricular function.

Conclusions

To our knowledge this is the first reported case of an overdose of Venlafaxine (SNRI) associated Tako Tsubo cardiomyopathy.

Keywords: Serotonin–norepinephrine reuptake inhibitor, Venlafaxine, Tako Tsubo cardiomyopathy, Apical ballooning, Pathogenesis