Takotsubo cardiomyopathy triggered by major depressive disor
The present case has been published in BMJ. A 28-year-old gravida 7 para 5 woman presented from an outlying facility with non-radiating, crushing, severe left-sided chest pain. She was initially treated for a non-ST elevation myocardial infarction with ECG evidence of T wave inversions in leads II, III, aVF, V5, V6 and an abnormal troponin level at 0.56 ng/mL.

Accordingly, left heart catheterisation was performed emergently and revealed normal coronary arteries without any obstruction. Left ventriculography showed mid-ventricular hypokinesis with hyperdynamic apical and basal wall contraction, consistent with a mid-ventricular takotsubo cardiomyopathy (TCM). The ejection fraction was estimated at 30%–35%.

Medical history was significant for an elective abortion performed by dilation and curettage at 12 weeks of pregnancy (8 weeks prior to presentation), followed by new-onset depression and suicidal ideation. She was not taking any medications at home. She denied alcohol consumption or tobacco use. A toxicology screen was negative for cocaine and amphetamines.

There were no clinical signs of heart failure. She was treated medically with carvedilol, lisinopril and spironolactone. The psychiatry and obstetrical teams evaluated her during her hospitalisation. She was eventually discharged home in stable condition after optimisation of cardiac management and improvement of her psychological state.

Learning points
• Takotsubo cardiomyopathy (TCM) in the perinatal period needs to be differentiated from myocardial infarction, pulmonary thromboembolism, amniotic fluid embolisation and peripartum cardiomyopathy.

• An elective abortion followed by emotional distress may trigger TCM.

• There are no current clear recommendations regarding subsequent pregnancies for patients with a history of TCM.

Read in detail here: http://casereports.bmj.com/content/2018/bcr-2018-226977.full