The recurrence rate of
takotsubo syndrome (TS) has been reported as 1.8% per patient-year while left ventricular outflow tract (
LVOT) obstruction is comorbid in 10-25% of all instances of TS. The
clinical course of recurrent TS with associated LVOT while on haemodialysis has rarely been reported.
CASE SUMMARY: This case report involves a 60-year-old female patient receiving regular haemodialysis who was admitted for
chest pain during ballroom dancing. Four years prior, she had suffered TS, and fully recovered after the hospitalization. An emergent coronary angiogram done during the second hospitalization showed no significant
stenosis, and left ventriculography demonstrated mid-apical akinesia and basal
hyperkinesia. Based on these findings, we diagnosed the recurrence of TS. Later in the admission,
chest pain reappeared with the start of haemodialysis. A transthoracic echocardiogram demonstrated mean pressure gradient (PG) of LVOT was 58 mmHg, with systolic anterior motion of the mitral valve and basal-wall
hyperkinesia. The main aetiology for her symptoms was considered as an exacerbation of
LVOT obstruction due to removing intravascular volume by haemodialysis. After starting
landiolol at 3 μg/kg/min, PG of LVOT and symptoms gradually improved with uptitration of
landiolol. Finally, her
chest pain resolved when mean PG of LVOT was down to 38 mmHg using 10 μg/kg/min of
landiolol.
DISCUSSION: To our knowledge, this is the first report of a recurrent TS case comorbid with
LVOT obstruction while on regular haemodialysis.
Landiolol, the ultrashort-acting beta-blocker, may be a promising therapeutic option for rapid recovery of increased PG due to
LVOT obstruction.