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Case report
Takotsubo syndrome in bipolar affective disorder with alcohol withdrawal syndrome
  1. Deshwinder Singh Sidhu1,
  2. Richard Farrelly1 and
  3. John Lally2,3,4
  1. 1Liaison Psychiatry, Mater Misericordiae University Hospital, Dublin, Ireland
  2. 2Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK
  3. 3Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
  4. 4Department of Psychiatry, Mater Misericordiae University Hospital, Dublin, Ireland
  1. Correspondence to Dr Deshwinder Singh Sidhu; deshwinder_sidhu{at}


A 40-year-old woman presented to the emergency department with epigastric pain and agitation. She recently separated from her husband and was consuming 30 units of alcohol daily for 5 days. She had a history of bipolar affective disorder, borderline personality disorder and alcohol dependence syndrome. Investigations revealed the following: elevated troponin I levels, ST elevation, early Q waves and prolonged QTc. Emergency angiogram confirmed Takotsubo’s appearance. Medications with QTc prolongation propensity were held. A multidisciplinary apporach was required. She was discharged 10 days later when medically stabilised. It was later discovered that she died unexpectedly the following month. Takotsubo syndrome is a rare but unique cause of cardiac failure. This case highlights the need to consider the differential of Takotsubo syndrome in people presenting with possible acute ischaemic events, particularly in those with a history of combined emotional and physical stressors and a background history of mood disorder.

  • psychiatry
  • heart failure
  • alcohol-related disorders
  • bipolar I disorder
  • cardiovascular medicine

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  • Contributors All three authors have met the criteria for authorship. In addition to that, DSS was primary investigator and involved in drafting the manuscript. RF and JL provided critical revision of the material.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Next of kin consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.