Venlafaxine Induced Acute Myocardial Infarction With Normal Coronary Arteries

The Use of Extracorporeal Life Support in a Patient Suffering from Venlafaxine Intoxication. A Case Report

Very few reports exist on serious cardiac complications associated with intake of serotonin-noradrenaline reuptake inhibitors. This paper describes and discusses the case of a patient who ingested a dose of 17.5 g venlafaxine. She developed a full serotonergic syndrome leading to multi-organ failure, including refractory cardiovascular shock, which was managed by early implantation of an extracorporeal life support (ECLS) system as a bridging strategy. This intervention was successful and resulted in full recovery of the patient.

Serotonin norepinephrine re-uptake inhibitor (SNRI)-, selective norepinephrine reuptake inhibitor (S-NRI)-, and exogenously administered norepinephrine-induced takotsubo syndrome: Analysis of published cases

BACKGROUND

Takotsubo syndrome (TS) may be triggered by numerous physical stress factors including exogenous Norepinephrine administration. The aim of this study is to report on the clinical features and outcome of serotonin-norepinephrine reuptake inhibitor (SNRI)-, selective NRI (S-NRI)-, and exogenously administered norepinephrine-induced TS in a largest possible cohort of published cases.

METHODS

A computer assisted search of the electronic data base Pubmed was performed from 1990 to August 2016. All cases deemed to have SNRI-, S-NRI-, and norepinephrine-induced TS were retrieved.

RESULTS

Twenty two cases of SNRI-, S-NRI-, and norepinephrine-induced TS were retrieved from the literature. At presentation, the 22 patients with TS were 11 to 82years of age (mean age 49.9±20years). Seventeen of 21 (81%) of the patients were women. The most common presenting symptom was chest pain, which occurred in 59% of cases. The TS localization pattern was apical in 68%, mid-ventricular in 13.6%, basal in 13.6% and global in 4.5% of cases. Complications occurred in 7 of 22 (32%) with more complications in exogenously administered norepinephrine-induced TS (4 of 6, 66.7%) than SNRI-, and S-NRI-induced TS (3 of 16, 18, 8%) (p=0.054). All 4 male patients in the study developed complications. One patient (exogenous norepinephrine-induced TS) died during hospitalization.

CONCLUSION

The SNRI-, and S-NRI-induced TS have clinical features, complications and course comparable to that of all-TS population cohorts, whereas the exogenously administered norepinephrine-induced TS has a more dramatic clinical presentation and complication rates, which resembles that of exogenously administered epinephrine-induced TS.

Occurrence of Tako-Tsubo cardiomyopathy in association with ingestion of serotonin/noradrenaline reuptake inhibitors

Tako-Tsubo cardiomyopathy (TTC) occurs particularly in post-menopausal women, being precipitated in many cases by severe emotional stress. We describe six patients in whom TTC occurred in association with therapeutic ingestion or overdose of the serotonin/noradrenaline reuptake inhibitor venlafaxine, or its metabolite desvenlafaxine. Importantly, two of the six cases were not post-menopausal women. An increased risk of TTC may account for some of the reported cardiovascular adverse effects of venlafaxine and similar agents.