"Broken heart syndrome" after separation (from OxyContin).
We describe a 61-year-old woman with "broken heart syndrome" (Takotsubo-like cardiomyopathy) after abrupt postsurgical withdrawal of OxyContin. Her medical history was remarkable for long-term opiold dependence associated with the treatment of multi-Joint degenerative osteoarthritis. The patient presented to the emergency department 1 day after discharge from the hospital following total knee arthroplasty revision with acute-onset dyspnea and mild chest pain. She had precordial ST-segment elevation characteristic of acute myocardial infarction and elevated cardiac biomarkers. Emergency coronary angiography revealed no major coronary atherosclerosis. However, the left ventricular ejection fraction was severely decreased (26%), and new regional wall motion abnormalities typical of broken heart syndrome were noted. In addition to resuming her opioid therapy, she was treated supportively with bilevel positive airway pressure, diuretic therapy, morphine, aspirin, metoprolol, enalaprilat, intravenous heparin, nitroglycerin infusion, and dopamine infusion. Ventricular systolic function recovered completely by the fourth hospital day. To our knowledge, broken heart syndrome after opioid withdrawal has not been reported previously in an adult. Our case illustrates the importance of continuing adequate opiate therapy perioperatively in the increasing number of opioid-dependent patients to prevent potentially life-threatening complications such as broken heart syndrome.
Rivera
Juanita M
JM
Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA.
Locketz
Adam J
AJ
Fritz
Kevin D
KD
Horlocker
Terese T
TT
Lewallen
David G
DG
Prasad
Abhiram
A
Bresnahan
John F
JF
Kinney
Michelle O
MO
D000701:Analgesics, Opioid / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee; D009202:Cardiomyopathies / Q000139:chemically induced* / Q000175:diagnosis; D005260:Female; D006801:Humans; D008875:Middle Aged; D010003:Osteoarthritis / Q000188:drug therapy; D010098:Oxycodone / Q000009:adverse effects*; D019990:Perioperative Care; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis / Q000209:etiology; D013577:Syndrome; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced* / Q000175:diagnosis
D000701:Analgesics, Opioid; D010098:Oxycodone