Case Report| Volume 25, ISSUE 5, P316-318, May 2022

Buprenorphine withdrawal induced takotsubo cardiomyopathy: A series of unfortunate events

Published:January 04, 2022DOI:


      This case report describes a 64-year-old female with history of previous intravenous drug abuse on opioid substitution treatment with buprenorphine, who presented to the emergency department with angina and electrocardiographic findings suggestive of acute coronary syndrome. Echocardiography and left ventriculography were indicative of takotsubo cardiomyopathy, probably attributed to abrupt discontinuation of buprenorphine. Opioid withdrawal leads to sympathetic hyperactivity and increased catecholamine release, which in our case triggered takotsubo cardiomyopathy presentation.
      <Learning objective: Buprenorphine withdrawal may precipitate takotsubo cardiomyopathy.>


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        • Lyon AR
        • Bossone E
        • Schneider B
        • Sechtem U
        • Citro R
        • Underwood SR
        • Sheppard MN
        • Figtree GA
        • Parodi G
        • Akashi YJ
        • Ruschitzka F
        • Filippatos G
        • Mebazaa A
        • Omerovic E.
        Current state of knowledge on Takotsubo syndrome: a Position Statement from the Taskforce on Takotsubo Syndrome of the Heart Failure Association of the European Society of Cardiology.
        Eur J Heart Fail. 2016; 18: 8-27
        • Prasad A
        • Lerman A
        • Rihal CS.
        Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction.
        Am Heart J. 2008; 155: 408-441
        • Akashi YJ
        • Goldstein DS
        • Barbaro G
        • Ueyama T.
        Takotsubo cardiomyopathy: a new form of acute, reversible heart failure.
        Circulation. 2008; 118: 2754-2762
        • Gianni M
        • Dentali F
        • Grandi AM
        • Sumner G
        • Hiralal R
        • Lonn E
        Apical ballooning syndrome or takotsubo cardiomyopathy: a systematic review.
        Eur Heart J. 2006; 27: 1523-1529
        • Lazaros G
        • Dimitriadis K
        • Xanthopoulou M
        • Latsios G
        • Antoniou C
        • Lazarou E
        • Tousoulis D.
        Takotsubo cardiomyopathy and Parkinson's disease: An exceptionally uncommon clinical duet.
        Hellenic J Cardiol. 2019; 60: 334-335
        • Latsios G
        • Synetos A
        • Mastrokostopoulos A
        • Vogiatzi G
        • Bounas P
        • Nikitas G
        • Papanikolaou A
        • Parisis C
        • Kanakakis I
        • Goudevenos J.
        Cardiopulmonary resuscitation in patients with suspected or confirmed Covid-19. A consensus of the Working group on CardioPulmonary Resuscitation of the Hellenic Society of Cardiology.
        Hellenic J Cardiol. 2021; 62: 24-28
        • Lemesle F
        • Lemesle F
        • Nicola W
        • Pierre Jonville-Béra A
        First case of stress cardiomyopathy as a result of methadone withdrawal secondary to drug-drug interaction.
        Am J Emerg Med. 2010; 28 (.e5-6): 387
        • Saiful FB
        • Lafferty J
        • Jun CH
        • Teli S
        • Duvvuri S
        • Khattri S
        • Bhat T.
        Tako-Tsubo cardiomyopathy due to iatrogenic methadone withdrawal.
        Rev Cardiovasc Med. 2011; 12: 164-167
        • Spadotto V
        • Zorzi A
        • El Maghawry M
        • Meggiolaro M
        • Pittoni GM.
        Heart failure due to ‘stress cardiomyopathy’: a severe manifestation of the opioid withdrawal syndrome.
        Eur Heart J Acute Cardiovasc Care. 2013; 2: 84-87
        • Elkader A
        • Sproule B.
        Buprenorphine: clinical pharmacokinetics in the treatment of opioid dependence.
        Clin Pharmacokinet. 2005; 44: 661-680