'Takotsubo' cardiomyopathy in a maintenance hemodialysis patient.
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.
Department of Medicine II, Kansai Medical University, Osaka, Japan.
Masayoshi
M
Fukui
Yasukiyo
Y
Mori
Satoshi
S
Tsujimoto
Kazuya
K
Takehana
Norihiko
N
Sakamoto
Noriko
N
Kishimoto
Takanobu
T
Imada
Hirofumi
H
Maeba
Atsuko
A
Nose
Hideki
H
Yamahara
Yasuaki
Y
Kijima
Tetsuya
T
Kitamura
Takanao
T
Ueyama
Sanae
S
Kikuchi
Toshiko
T
Tokoro
Hiroya
H
Masaki
Mitsushige
M
Nishikawa
Toshiji
T
Iwasaka
D000369:Aged, 80 and over; D009202:Cardiomyopathies / Q000175:diagnosis / Q000209:etiology*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications; D006435:Renal Dialysis; D013315:Stress, Psychological / Q000150:complications