Takotsubo Syndrome Associated with Benzodiazepine Withdrawal: A Case Report

Peter Flores¹, Sabina Kumar^1, , Umeh Chukwuemeka¹, Jose Penaherrera¹, Pranav Barve¹ and Shivang Shah^{2, 3}

¹Department of Internal Medicine, Hemet Global Medical Center, Hemet, California, USA

²Division of Cardiology, University of California Riverside School of Medicine, Riverside, California, USA

³Divison of Cardiology, Loma Linda University School of Medicine, Loma Linda, California, USA

Cite this paper

Peter Flores, Sabina Kumar, Umeh Chukwuemeka, Jose Penaherrera, Pranav Barve and Shivang Shah. Takotsubo Syndrome Associated with Benzodiazepine Withdrawal: A Case Report. American Journal of Medical Case Reports. 2021; 9(12):672-674. doi: 10.12691/AJMCR-9-12-2

Abstract

Since the 1960s, benzodiazepines have been a clinical mainstay, utilized for sedation, anxiety, and withdrawal states. Between 1996 and 2013 alone, benzodiazepine prescriptions increased annually by 2.5%. Rather than risk symptoms of withdrawal such as muscle pain and severe cardiomyopathy, patients must be properly informed about how to taper their medications. A 75-year-old female with a history of anxiety, hypertension, lupus, and degenerative disc disease presented with palpitations, mid-sternal chest pain, diaphoresis, and progressive shortness of breath. The patient was found to have elevated troponins (peak troponin of 1.45) and EKG showed sinus rhythm and ST segment abnormalities. The patient stated that her chest pain started 24 hours ago, 48 hours after she had stopped taking lorazepam which she had been taking for the past 50 years for anxiety. Her PCP gave her a plan to taper down the dose of lorazepam safely, but the patient opted to stop “cold turkey.” Due to the patient’s typical chest pain and elevating troponin level, ACS protocol was initiated. Initial echocardiogram showed an ejection fraction of 35-40% with hypokinesis of the anterioseptal wall with impaired left ventricular diastolic filling. The cardiology team performed a catheterization which showed minimal coronary artery disease and no significant stenosis in the left anterior descending artery. Within the next few days, the patient’s chest pain resolved and her troponins were negative. The medical team concluded that the physical stress from withdrawing from benzodiazepine caused the patient to go into Takotsubo Cardiomyopathy. This case illustrates the risks involved with benzodiazepine in an era of polypharmacy. More importantly, this case illustrates the strong need to taper benzodiazepines properly. Because this patient had taken a benzodiazepine for 50 years, the tapering should have been as slow as possible. The result was Takotsubo cardiomyopathy.

Keywords

cardiomyopathy, takotusubo, benzodiazepine withdrawal, polypharmacy abuse

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

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