‘Takotsubo’ Cardiomyopathy in a Maintenance Hemodialysis Patient

Abstract

An 84-year-old woman undergoing maintenance hemodialysis presented with chest discomfort lasting several days and electrocardiographic abnormalities. She had stopped smoking 2 weeks earlier and was experiencing irritability. Upon admission, electrocardiography showed ST-segment elevation in leads I, II, aVF, and V2-6 and an abnormal Q wave in leads II, III, and aVF. Ultrasound cardiography showed left ventricular anteroapical akinesia and basal hyperkinesia. The chest discomfort disappeared without specific therapy. During hospital days 1-5, the ST-segment elevation gradually improved. Giant negative T waves then developed. The left ventricular asynergy resolved by day 8. Radionuclide imaging with iodine-123-beta-methyl-p-iodophenyl pentadecanoic acid, but not with technetium-99 m-sestamibi, showed an apical defect. Elective coronary angiography showed no stenosis. 'Takotsubo' cardiomyopathy was diagnosed. After discharge, the patient continued regular dialysis without cardiac symptoms. We concluded that endogenously activated sympathetic nerve action in hemodialysis patients, especially those under emotional or physical stress, might be a causative factor for Takotsubo cardiomyopathy.

Takotsubo Syndrome during Haemodialysis

“…[17] Also in hemodialysis, patients often coexist anemia, poor nutrition, muscle weakness, associated diabetes mellitus, volume overload, and other comorbidities that lead to poor quality of life and increased physical and emotional stress, which are substrate for TS. [518] The case we present is the 11 th case of a patient on hemodialysis who presented TS. Contrary to our patient, half of all these published cases presented with atypical symptoms.…”

Takotsubo Cardiomyopathy in Two Patients without Any Cardiac Symptom on Maintenance Hemodialysis

“…On the other hand, in epidemiologic studies, some cases of acute renal failure were reported; however, only three cases of takotsubo cardiomyopathy in maintenance hemodialysis patients have been described so far [1, 7, 20–29]. We list the known cases of takotsubo cardiomyopathy in patients on maintenance hemodialysis in Table 1 [27–29]. Factors as a trigger for takotsubo cardiomyopathy are various.…”

Perioperative Stress-Induced (Takotsubo) Cardiomyopathy in Liver Transplant Recipients

“…In these cases, reductions in myocardial blood flow, consistent with the development of myocardial ischemia, may have caused myocardial stunning, with resolution after cessation of HD(31). Cases of typical TC during HD sessions have also been reported (32,33).…”