title: 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.
authors.affiliation: University of Technology Dresden, Department of Cardiology, Heart Center, University Hospital, Dresden, Germany. Marian.Christoph@mailbox.tu-dresden.de
authors.forename: Marian
authors.initials: M
authors.lastname: Christoph
authors.forename: Bernd
authors.initials: B
authors.lastname: Ebner
authors.forename: Dirk
authors.initials: D
authors.lastname: Stolte
authors.forename: Karim
authors.initials: K
authors.lastname: Ibrahim
authors.forename: Steffen
authors.initials: S
authors.lastname: Kolschmann
authors.forename: Ruth H
authors.initials: RH
authors.lastname: Strasser
authors.forename: Steffen
authors.initials: S
authors.lastname: Schön
mesh_terms: D000328:Adult; D018687:Antidepressive Agents, Second-Generation / Q000097:blood / Q000506:poisoning*; D003511:Cyclohexanols / Q000097:blood / Q000506:poisoning*; D003863:Depression / Q000188:drug therapy*; D062787:Drug Overdose; D004452:Echocardiography; D005260:Female; D006801:Humans; D009638:Norepinephrine / Q000378:metabolism / Q000652:urine; D017367:Selective Serotonin Reuptake Inhibitors / Q000097:blood / Q000506:poisoning*; D054549:Takotsubo Cardiomyopathy / Q000139:chemically induced* / Q000503:physiopathology; D000069470:Venlafaxine Hydrochloride
chemical_list: D018687:Antidepressive Agents, Second-Generation; D003511:Cyclohexanols; D009638:Norepinephrine; D017367:Selective Serotonin Reuptake Inhibitors; D000069470:Venlafaxine Hydrochloride