Pickering syndrome: high-risk stenting of a renal artery stenosis in a multimorbid patient presenting with progressive congestive heart failure
Acute chest pain and progressive dyspnea led to the admission of an 83-year-old female patient with known severely impaired left ventricular (LV) function and secondary mitral regurgitation II° due to dilated cardiomyopathy (DCM). Recurrent decompensations had led to cardiac resynchronization therapy via defibrillator (CRT-D) implantation. Present cardiovascular risk stratification revealed metabolic syndrome (obesity, diabetes mellitus type 2, arterial hypertension and hyperlipoproteinemia) complicated by previous stroke, whereas relevant coronary artery disease had been excluded years before. Moreover, recurrent exacerbating obstructive lung disease (COLD, GOLD III) was reported and advanced renal failure was documented [K/DOQI III, serum creatinine 2.2 mg/dL, urea 96 mg/dL, glomerular filtration rate (GFR, MDRD) 23 mL/min]. Initial clinical examination revealed wheezing over both lungs and mild edema of the lower limbs. There was sinus rhythm at a normal heart rate and...
KeywordsRenal Artery Cardiac Resynchronization Therapy Resistance Index Renal Artery Stenosis Eplerenone
Conflict of interest
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