Takotsubo cardiomyopathy (CT) is a syndrome characterized by an acute and transient
left ventricular dysfunction, electrocardiographic abnormalities suggestive of
acute coronary syndrome,
chest pain and/or
dyspnea, left ventricular mid-apical segments akinesia and normal coronary angiography. It is mainly observed in postmenopausal women after an intense physical or mental stress. The course is usually favourable but sometimes severe complications occur. The recurrence rate is 2-10%. We present the case of a recurrence of CT in a female, 79 years old, with
hypertension, diabetes,
chronic kidney disease (CKD) stage 3 who was admitted to the emergency room for
dyspnea and
vomiting. The electrocardiogram (ECG) showed a sinusal rhythm and T wave inversion in the pre-cordial leads and the echocardiogram a typical feature of CT with depressed left ventricular systolic function (FE). The ECG ranged quickly with
atrial fibrillation rhythm, followed by a major hypokinetic
arrhythmia with advanced atrio-ventricular block which indicated the need for a temporary pacemaker placement. The patient was oligouric, with severe
renal failure,
hyponatremia,
hyperkalemia and
metabolic acidosis. A
continuous renal replacement therapy (CRRT) was started. On the seventh day improvement in urine output,
electrolyte and
acid base imbalance and FE normalization occurred. The renal function improved gradually, but after 36 months, persisted CKD stage 4. The case report describes the development of a
cardiorenal syndrome type 1 induced by CT recurrence and effectiveness of CRRT in the management of acute
heart failure. It also suggests a potential role played by CKD as a risk factor in the onset and recurrence of CT.