Case Report: A woman with schizophrenia who died due to Takotsubo cardiomyopathy occurring after electroconvulsive therapy

Abstract Background Electroconvulsive therapy (ECT) is a safe treatment for treatment-resistant schizophrenia. However, it has some side effects, and Takotsubo cardiomyopathy is considered one of the minor complications. Several cases of patients developing Takotsubo cardiomyopathy during a course of ECT have been reported, but none have died. We present a case of post-ECT Takotsubo cardiomyopathy that became fatal. Case presentation We experienced a case of a 67-year-old woman who had delusions and catatonic symptoms due to schizophrenia but was resistant to several medications. Her symptoms improved by conducting ECT, but she had difficulty maintaining her improvement, which caused her to receive multiple courses of ECT. A month after her 6th course of ECT, the patient developed Takotsubo cardiomyopathy that had a fatal outcome. Conclusion Our patient had numerous cases of aspiration pneumonitis and malnutrition before ECT was preformed, which might have made this case fatal. In conclusion, appropriate supplementation of nutrition and reduction of physical stressors are important to avoid deaths from Takotsubo cardiomyopathy caused by ECT. Prescribing clozapine might have been a solution in the present case, but there are some difficulties, such as the restriction against prescribing this drug in Japan.