Takotsubo cardiomyopathy in a patient with bipolar disorder

A 48-year-old woman, with medical history of bipolar disorder and no previous cardiovascular disease, presented to the emergency department with acute onset of typical angina. Pain improved with sublingual nitroglycerin, but did not resolve completely. She reported to have similar brief episodes of self-resolving chest pain for the last 2 weeks, which she interpreted as panic attacks. Her home medications included lamotrigine 100 mg and paroxetine 20 mg started many years ago. Her lab results were significant for elevated troponin at 5.5 ng/mL and normal thyroid-stimulating hormone level. ECG did not show any acute ischaemic changes. Subsequently, the patient underwent coronary angiography, which did not …