Slow on the Uptake, Progression to Heartbreak

• Type of Material: Article
• Authors: Ashley K. Binder, Emory University; John Haydek, Emory University; Siddhant Parihar, Emory University; Chelsea E. Modlin, Emory University; Manasi Tannu, Emory University; Amalia Aldredge, Emory University; Viranuj Sueblinvong, Emory University
• Language: English
• Date: 2020-01-01
• Publisher: SAGE Publications Ltd.
• Publication Version: Final Published Version
• Copyright Statement: © 2020 American Federation for Medical Research
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1177/2324709620936832
• Title of Journal or Parent Work: Journal of Investigative Medicine High Impact Case Reports
• Volume: 8
• Start Page: 2324709620936832
• End Page: 2324709620936832
• Grant/Funding Information: The author(s) received no financial support for the research, authorship, and/or publication of this article.
• Keywords: Serotonin Syndrome; Substance-Related Disorders; serotonin syndrome; Echocardiography; Takotsubo Cardiomyopathy; Humans; multi-organ failure; Intensive Care Units; Adult; Serotonin Uptake Inhibitors; Multiple Organ Failure; takotsubo cardiomyopathy; Female
• Research Categories: Biology, Physiology; Health Sciences, Pathology; Health Sciences, Medicine and Surgery

Abstract

The prevalence of serotonin syndrome increases over the past several years as more serotonergic medications are being used in clinical practice. It is a potentially lethal condition caused by excessive serotonergic activity. Common causes of serotonin syndrome are the use of prescription medications, illicit drugs, or a combination of substances, leading to an increase in the activity of serotonin in the central and peripheral nervous system. The clinical symptoms range from mild to severe. We report a case of a 25-year-old woman with polysubstance abuse, including cocaine, who presented with confusion, rigidity, high-grade fever, and reduced biventricular function on echocardiogram. Based on the combination of substance used history, clinical presentation, and echocardiogram findings, she was diagnosed with serotonin syndrome complicated by takotsubo cardiomyopathy. She improved after being treated in the intensive care unit and was discharged from the hospital. This patient demonstrates the importance of recognizing and promptly initiating management of serotonin syndrome in order to improve morbidity and mortality.