RENAL ARTERY STENOSIS AS A CAUSE OF TAKOTSUBO CARDIOMYOPATHY

V SASONGKO1, R QASABIAN1,2, S MAY1

1Tamworth Rural Referral Hospital, Tamworth, NSW;  2Royal Prince Alfred, Sydney, NSW

Background: Takotsubo cardiomyopathy, a transient cardiac syndrome that mimics acute coronary syndrome, is thought to be precipitated by sympathetic nervous system activation. Renal artery stenosis (RAS) induces hypertension by several mechanisms, including the rise in serum cathecolamines. We describe a case of Takotsubo cardiomyopathy in a patient with RAS and propose a causal association between the two phenomenon.

Case report: A 78-year-old female haemodialysis patient with background history of hypertension and anxiety presented with acute dyspnoea, elevated troponin and anterior ST-segment changes on electrocardiogram. An echocardiogram performed three months earlier showed normal left ventricular systolic function with Ejection Fraction (EF) of 67%.

Our patient had recently commenced haemodialysis six weeks earlier following a presentation with acute kidney impairment (creatinine of 734mmol/l). She was noted to have small left kidney and a 11.6cm non-obstructed right kidney. Renal biopsy showed viable kidney with mild mesangial matrix expansion.

A repeat echocardiogram showed a severe left ventricular systolic dysfunction (EF of 32%) and coronary angiography was suggestive of Takotsubo cardiomyopathy with minimal coronary artery disease. A renal angiogram was performed at the same time due to our suspicion of RAS and this confirmed no identifiable flow to the right kidney.

Given the apparent viability of the right kidney, angioplasty and stenting of right renal artery was performed, resulting in dramatic improvement of dyspnoea, a return to normal cardiac function and a gradual recovery of renal function. Our patient is currently off dialysis with creatinine of 129mmol/l.

Conclusion: Renal artery stenosis can be suspected as a rare cause of Takotsubo Cardiomyopathy. Stenting of the stenosed renal artery may result in the recovery of renal function and cardiac function.

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