Cor Vasa 2013, 55(3):e277-e280 | DOI: 10.1016/j.crvasa.2012.09.005

Biventricular Takotsubo syndrome in a patient with coronary abnormality and end-stage renal disease

Ferit Onur Mutluer^a, Rosalinda Madonna^b,c, Cihan Cevik^b, Maher M. Nasser^b, Raffaele De Caterina^c,*

^a Department of Cardiology, Siyami Ersek Cardiovascular Surgery Center, Istanbul, Turkey

^b Texas Heart Institute and St. Luke's Episcopal Hospital, Houston, TX, USA

^c Institute of Cardiology, G. d'Annunzio University, Chieti, Italy

The Takotsubo syndrome is a clinical entity consisting of transient, regional left ventricular (LV) contraction abnormalities in the absence of significant epicardial coronary artery disease. Patients usually present with acute hemodynamic deterioration following an emotional or physical stress. The Takotsubo syndrome is uncommon among patients with end-stage renal disease (ESRD) and patients with congenital coronary abnormalities, such as right coronary artery (RCA) originating from left sinus of Valsalva. Here we describe a patient presenting with acute respiratory distress and anterolateral ST-T segment changes, with negative troponin-I and elevated levels of brain natriuretic peptide. Coronary angiography showed a right coronary artery arising from the left sinus of Valsalva without obstructive coronary artery disease, while ventriculography and echocardiogram showed findings compatible with apical ballooning. Magnetic resonance imaging confirmed the diagnosis of a biventricular Takotsubo cardiomyopathy.

Keywords: Apical ballooning; Coronary artery anomalies; End-stage renal disease; Takotsubo syndrome

Received: September 5, 2012; Accepted: September 13, 2012; Published: June 1, 2013  Show citation