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

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 echo-cardiogram showed findings compatible with apical ballooning. Magnetic resonance imaging confirmed the diagnosis of a biventricular Takotsubo cardiomyopathy. (C) 2012 The Czech Society of Cardiology. Published by Elsevier Urban & Partner Sp.z.o.o. All rights reserved.