ABSTRACT
Background/Significance: Electroconvulsive therapy (ECT) is a safe procedure with infrequent cardiovascular complications. Takotsubo cardiomyopathy (TC) associated with ECT has been rarely reported. Cases: JP is a 67-year-old woman with Schizoaffective Disorder, admitted for psychosis and depressive symptoms. ECT was planned given lack of response to multiple antipsychotics, including clozapine, prior to admission. After the first ECT, patient had elevated troponin, EKG with precordial biphasic T-waves and T-wave inversions, prolonged QTc, negative coronary CT angiogram, and apical wall motion abnormality in TTE with preserved LVEF. Cardiac abnormalities were hypothesized to be due to clozapine-related myocarditis, TC, or sarcoidosis, and clozapine was replaced with haloperidol. ECT was resumed and notable for episodes of bradycardia requiring glycopyrrolate, and hypertension requiring labetalol, yet after 12 sessions, most of her psychosis and depressive symptoms remitted. MT is a 50-year-old woman with MDD with psychotic features, admitted after suicide attempt by hanging. While in NICU, patient was found to have TC with anterior T-wave inversion on EKG and apical hypokinesis in TTE. New EKG 12 days later for ECT clearance showed anteroseptal ST changes suggestive of ischemia, but coronary CTA was normal, and repeat TTE showed no segmental wall motion abnormalities. ECT was started without further cardiac issue but was discontinued after 5 sessions due to marked improvement in depressive symptoms while having intermittent episodes of post-ECT fever and COVID infection with multifocal pneumonia. NE is a 68-year-old woman with MDD with psychotic features, catatonia, and suspected TC after ECT in 2007, admitted for severe catatonia. During ECT session 3, patient had 4 seconds of asystole on telemetry, immediately following succinylcholine with rapid return of palpable pulse, stable heart rate and blood pressure. Post-procedure EKG and recent TTE were normal, and ECT was continued with rocuronium and sugammadex instead of succinylcholine given its associated risk of asystole. Patient did not have any further episodes of asystole or arrythmia but required multiple medications for high blood pressure during ECT sessions. Discussion(s): Regardless of whether TC was diagnosed during the course or prior to initiation of ECT, the decision to perform ECT was based on patient's symptoms and overall cardiac function. 20 cases of TC associated with ECT have been reported with successful resumption of ECT in 8 cases and varying use of beta-blocker to prevent secondary TC. The reported time between TC and ECT ranges from weeks to months, with our cases being approximately 2 weeks (Medved 2018). Conclusion/Implications: ECT can be safely performed on patients with recent, including intercurrent, or remote TC with pharmacological management to mitigate cardiovascular risks. Reference: Medved S, et al: Takotsubo cardiomyopathy after the first electroconvulsive therapy regardless of adjuvant beta-blocker use: a case report and literature review. Croat Med J. 2018;59:307-12. Copyright © 2022
ABSTRACT
Resumen Próximo a su 25 aniversario CENTIS reflexiona sobre su quehacer en el contexto de los trastornos que causa la COVID-19. Con ese propósito se examinan el estado de la medicina nuclear y la radiofarmacia antes y durante la epidemia y sus perspectivas de desarrollo. La producción global de radiofármacos continúa siendo una industria consolidada y aunque la pandemia afecta a esta esfera, la presencia de otras enfermedades no cesa, por lo que los servicios de medicina nuclear esenciales y críticos siguen siendo necesarios. Se espera su paulatina reapertura y que se retome con más fuerza la investigación, dado que la COVID-19 es tan compleja y se asocia a tantos factores que constituye, en perspectiva, terreno virgen para las técnicas diagnósticas en medicina nuclear. Ha de permanecer asimismo el papel de los radiofármacos terapéuticos en un grupo importante de enfermedades, en cáncer sobre todo. El Centro de Isótopos pone por ello énfasis tanto en la consolidación, bajo buenas prácticas, de la producción y el suministro de radiofármacos, como en el desarrollo de nuevos productos. Ambos aspectos se basan principalmente en dos radionúclidos: Tc-99m e Y-90. Close to its 25th anniversary, CENTIS evaluates its work in the context of the disorders triggered by COVID-19. For this purpose, the situation of nuclear medicine and radiopharmacy, before and during the epidemic and their current development prospects is examined. The production of radiopharmaceuticals continues to be a consolidated global industry and although the pandemic affects this area, the presence of other diseases does not cease, so essential and critical nuclear medicine services are still needed, therefore its gradual reopening is expected. In addition, research will be taken with more strength, given that COVID-19 is so complex and associated with so many factors that it constitutes virgin terrain in perspective for diagnostic techniques in nuclear medicine. The role of therapeutic radiopharmaceuticals in an important set of diseases, especially cancer, will also remain. As a result, the Isotope Center focus its attention under good management practices, on the consolidation of the production and distribution of radiopharmaceuticals and in the development of new products. Both aspects are mainly based on two radionuclides: Tc-99m and Y-90.
ABSTRACT
Resumen Próximo a su 25 aniversario CENTIS reflexiona sobre su quehacer en el contexto de los trastornos que causa la COVID-19. Con ese propósito se examinan el estado de la medicina nuclear y la radiofarmacia antes y durante la epidemia y sus perspectivas de desarrollo. La producción global de radiofármacos continúa siendo una industria consolidada y aunque la pandemia afecta a esta esfera, la presencia de otras enfermedades no cesa, por lo que los servicios de medicina nuclear esenciales y críticos siguen siendo necesarios. Se espera su paulatina reapertura y que se retome con más fuerza la investigación, dado que la COVID-19 es tan compleja y se asocia a tantos factores que constituye, en perspectiva, terreno virgen para las técnicas diagnósticas en medicina nuclear. Ha de permanecer asimismo el papel de los radiofármacos terapéuticos en un grupo importante de enfermedades, en cáncer sobre todo. El Centro de Isótopos pone por ello énfasis tanto en la consolidación, bajo buenas prácticas, de la producción y el suministro de radiofármacos, como en el desarrollo de nuevos productos. Ambos aspectos se basan principalmente en dos radionúclidos: Tc-99m e Y-90. Close to its 25th anniversary, CENTIS evaluates its work in the context of the disorders triggered by COVID-19. For this purpose, the situation of nuclear medicine and radiopharmacy, before and during the epidemic and their current development prospects is examined. The production of radiopharmaceuticals continues to be a consolidated global industry and although the pandemic affects this area, the presence of other diseases does not cease, so essential and critical nuclear medicine services are still needed, therefore its gradual reopening is expected. In addition, research will be taken with more strength, given that COVID-19 is so complex and associated with so many factors that it constitutes virgin terrain in perspective for diagnostic techniques in nuclear medicine. The role of therapeutic radiopharmaceuticals in an important set of diseases, especially cancer, will also remain. As a result, the Isotope Center focus its attention under good management practices, on the consolidation of the production and distribution of radiopharmaceuticals and in the development of new products. Both aspects are mainly based on two radionuclides: Tc-99m and Y-90.