A patient with possible dementia with Lewy bodies (DLB) who presented with Takotsubo cardiomyopathy
Article first published online: 24 MAR 2010
© 2010 The Authors. Journal compilation © 2010 Japanese Society of Psychiatry and Neurology
Psychiatry and Clinical Neurosciences
Volume 64, Issue 2, page 213, April 2010
How to Cite
Noguchi, M. and Yamaga, K. (2010), A patient with possible dementia with Lewy bodies (DLB) who presented with Takotsubo cardiomyopathy. Psychiatry and Clinical Neurosciences, 64: 213. doi: 10.1111/j.1440-1819.2010.02068.x
- Issue published online: 24 MAR 2010
- Article first published online: 24 MAR 2010
- Received 30 July 2009; revised 16 October 2009; accepted 24 December 2009.
TAKOTSUBO CARDIOMYOPATHY (TC) is a rare, reversible condition that results in an abnormal electrocardiogram (ECG). Cardiologists recognize this disorder as stress-related heart disease because the symptoms are often precipitated by acute emotional stress, such as financial loss, natural disasters or accidents.1 There are very few reports in the psychiatric literature regarding this condition. Here, we report the case of a 61-year-old woman with possible dementia with Lewy bodies (DLB), who also exhibited TC. Informed consent was obtained from the patient.
The patient presented with depressed mood and decreased motivation. She was diagnosed with major depression and prescribed 50 mg of amoxapine, which improved her condition.
One year later, she was admitted to our hospital with depressed mood and loss of appetite. She exhibited no chest complaints; however, routine electrocardiogram revealed deep inverted T waves in precordial leads V2 to V6 and in limb leads I, II, III, and aVF. Creatine kinase was 63 IU/L (normal range: 12–144). Troponin T was negative. Emergency cardioangiography (CAG) demonstrated decreased wall motion in the apical and mid-portion of the left ventricle with no significant stenosis of the coronary arteries. Based on these findings, the patient was diagnosed with TC. She had a favorable course with regards to the TC without specific cardiological intervention at that time or thereafter, and ECG findings were completely normal at the 7-month follow-up examination.
Two months after discharge, she became depressed again for unknown reasons and was readmitted to the hospital. Two months after admission, she began to demonstrate tremors, rigidity and bradykinesia. No visual hallucinations, rapid eye movement sleep behavior disorder, or fluctuations of consciousness were detected during the course of treatment.
Prior to her second admission, the patient complained of mild memory loss, which gradually became more pronounced. She scored 18 out of 30 points on the Revised Hasegawa Dementia Scale (cut-off point, 21 points). Magnetic resonance imaging demonstrated mild brain atrophy without marked change in hippocampal volume. Single photon emission computed tomography (SPECT) of the brain revealed decreased cerebral blood flow in the bilateral occipital lobe. I-metaiodobenzylguanidine (MIBG) cardiac scintigraphy was performed 3 years after the onset of TC, revealing decreased cardiac MIBG uptake.
Some improvement in condition was achieved with administration of l-dopa 100 mg and paroxetine 40 mg per day. The patient was diagnosed with possible DLB on the basis of gradual cognitive decline, Parkinsonism, symptoms of depression, and the results of SPECT and MIBG cardiac scintigraphy.2
Takotsubo cardiomyopathy is mostly seen in postmenopausal women presenting with abnormal ECG findings that are indistinguishable from acute myocardial infarction, and decreased left ventricular apical and mid-portion wall motion, without coronary artery stenoses. Catecholamine cardiotoxicity is considered one possible explanation for the pathophysiology of TC.3 Autonomic nerve impairment in DLB, as revealed by MIBG cardiac scintigraphy, might thus contribute to concomitant TC in DLB.
TC may be easily overlooked due to non-specific symptoms and self-limited course. Psychiatrists should be alert for signs and symptoms of this disorder, particularly when caring for postmenopausal women.