Electroconvulsive Therapy as a Trigger for Takotsubo Cardiomyopathy

Takotsubo cardiomyopathy (TCM) is a transient stress-induced cardiomyopathy characterized by acute left ventricular systolic dysfunction in the absence of obstructive coronary artery disease. Electroconvulsive therapy (ECT) is known to provoke acute autonomic fluctuations and catecholamine surges, which may rarely precipitate TCM. We presented a middle-aged woman with coronary artery disease (CAD), bipolar disorder, and remote tobacco use who developed acute substernal chest pain radiating to the left arm approximately four hours after her first outpatient ECT session. Transthoracic echocardiography demonstrated a left ventricular ejection fraction (LVEF) of 36% with akinesis of the mid-to-distal apical segments, consistent with TCM. She was managed supportively and discharged with close follow-up by cardiology and psychiatry. ECT-induced Takotsubo cardiomyopathy is an uncommon but clinically significant complication mediated by excess catecholamine release. Recognition is essential, particularly in postmenopausal women with cardiovascular risk factors. Development of TCM does not represent an absolute contraindication to future ECT but warrants multidisciplinary evaluation and cardiovascular optimization prior to resumption.