Clinical Research in Cardiology

, Volume 103, Issue 9, pp 759–761 | Cite as

Takotsubo cardiomyopathy in complicated Pickering syndrome: endovascular therapy of an occluded renal artery

  • Mario Jularic
  • Janosch Cupa
  • Mark Rosenberg
  • Norbert Frey
  • Christoph Langer
Letter to the Editors


A 62-year-old female patient was admitted to our hospital presenting with severe dyspnea and chest pain; no vegetative symptoms. Her medical history revealed chronic renal failure (K/DOQI III) and left nephrectomy 18 years before following renal cell carcinoma and hypertensive nephropathy. Moreover, there was hypertensive heart disease with a slightly reduced left-ventricular (LV) function [external echo: LV ejection fraction (EF) 45–50 % and diastolic dysfunction grade I]. The patient had repeatedly been hospitalized because of acute heart failure following hypertensive crises. In this context, on a CT angiography performed 6 months earlier an ostial stenosis of the right renal artery (RAS) had been described and considered irrelevant by the formerly treating institution. Her medications included low-dose aspirin, bisoprolol (10 mg), aliskiren (150 mg), amlodipine (10 mg), doxazosine (8 mg), moxonidine (0.8 mg), torasemid (20 mg) and pantozol (40 mg).

Initial clinical...


Renal Artery Aliskiren Urapidile Torasemid Takotsubo Cardiomyopathy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Sato TH, Uchida T (1990) Takotsubo-type cardiomyopathy due to multivessel spasm. Kagakuhyouronsya Co, Tokyo, pp 56–64Google Scholar
  2. 2.
    Pickering TG, Herman L, Devereux RB, Sotelo JE, James GD, Sos TA, Silane MF, Laragh JH (1988) Recurrent pulmonary oedema in hypertension due to bilateral renal artery stenosis: treatment by angioplasty or surgical revascularisation. Lancet 2(8610):551–552PubMedCrossRefGoogle Scholar
  3. 3.
    Wittstein IS, Thiemann DR, Lima JA, Baughman KL, Schulman SP, Gerstenblith G, Wu KC, Rade JJ, Bivalacqua TJ, Champion HC (2005) Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med 352(6):539–548PubMedCrossRefGoogle Scholar
  4. 4.
    Haghi D, Hamm K, Heggemann F, Walter T, Suselbeck T, Papavassiliu T, Borggrefe M (2011) Coincidence of coronary artery disease and Tako-Tsubo cardiomyopathy. Herz 35(4):252–256. doi: 10.1007/s00059-011-3447-2 CrossRefGoogle Scholar
  5. 5.
    Burgdorf C, Hunold P, Radke PW, Schunkert H, Kurowski V (2011) Isolated right ventricular stress-induced (“Tako-Tsubo”) cardiomyopathy. Clin Res Cardiol 100(7):617–619. doi: 10.1007/s00392-011-0293-4 PubMedGoogle Scholar
  6. 6.
    Ramaraj R, Movahed MR (2010) Reverse or inverted takotsubo cardiomyopathy (reverse left ventricular apical ballooning syndrome) presents at a younger age compared with the mid or apical variant and is always associated with triggering stress. Congest Heart Fail 16(6):284–286. doi: 10.1111/j.1751-7133.2010.00188.x PubMedCrossRefGoogle Scholar
  7. 7.
    Desmet WJ, Adriaenssens BF, Dens JA (2003) Apical ballooning of the left ventricle: first series in white patients. Heart 89(9):1027–1031PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Messerli FH, Bangalore S, Makani H, Rimoldi SF, Allemann Y, White CJ, Textor S, Sleight P (2011) Flash pulmonary oedema and bilateral renal artery stenosis: the Pickering syndrome. Eur Heart J 32(18):2231–2235. doi: 10.1093/eurheartj/ehr056 PubMedCrossRefGoogle Scholar
  9. 9.
    Zeller T, Macharzina R, Rastan A, Beschorner U, Noory E (2014) Renal artery stenosis: up-date on diagnosis and treatment. Vasa 43(1):27–38. doi: 10.1024/0301-1526/a000325 PubMedCrossRefGoogle Scholar
  10. 10.
    Sharkey SW, Windenburg DC, Lesser JR, Maron MS, Hauser RG, Lesser JN, Haas TS, Hodges JS, Maron BJ (2010) Natural history and expansive clinical profile of stress (Takotsubo) cardiomyopathy. J Am Coll Cardiol 55(4):333–341. doi: 10.1016/j.jacc.2009.08.057 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Mario Jularic
    • 1
    • 2
  • Janosch Cupa
    • 1
  • Mark Rosenberg
    • 1
  • Norbert Frey
    • 1
  • Christoph Langer
    • 1
  1. 1.Klinik für Innere Medizin III (Kardiologie, Angiologie und Intensivmedizin)Universitätsklinikum Schleswig-Holstein, Campus Kiel, Christian-Albrechts- Universität KielKielGermany
  2. 2.Klinik für Kardiologie mit Schwerpunkt ElektrophysiologieUniversitäres Herzzentrum HamburgHamburgGermany

Personalised recommendations