Acute heart failure secondary to takotsubo cardiomyopathy in a patient on peritoneal dialysis with residual renal function loss

Takotsubo cardiomyopathy (TTC) is characterized by clinical and electrocardio-graphic signs that mimic myocardial ischemia, typical left ventricular kinesis abnormalities, and no evidence of obstructive coronary disease. It is associated with emotional or physical stress usually in postmenopausal women. A major pathogenetic role is played by excessive sympathetic stimulation of the left ventricle. Only two cases of TTC have been described in patients on hemodialysis and one case has been described in a patient on peritoneal dialysis associated with peritonitis. We observed a case of TTC in a patient on nocturnal intermittent peritoneal dialysis with a transplanted kidney and loss of residual renal function. We found that she had suffered significant emotional stress immediately before the symptoms arose. The clinical features were typical ischemic chest pain and acute heart failure. Beta-blockers were the principal pharmacological treatment. The necessary ultrafiltration was obtained with peritoneal dialysis in automated modality, reducing the abdominal filling volumes according to the patient's compliance and modifying the glucose concentration according to her hemodynamic condition. The obtained ultrafiltration was appropriate and in accordance with the few experiences reported in the literature. The symptoms resolved within a week and the left ventricular kinesis and ejection fraction normalized in almost three weeks. This clinical case suggests that peritoneal dialysis, also in automated mode, can be as effective as extracorporeal ultrafiltration in the treatment of acute heart failure.