Τίτλος:
A Heartbreaking Renal Transplantation: Is Norepinephrine the Culprit to
Blame?
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Introduction. Takotsubo cardiomyopathy (TCM), also known as “broken
heart syndrome,” “apical ballooning syndrome,” and
“stress-induced cardiomyopathy,” was first described in Japanese
patients in 1990 by Sato et al. TCM is an increasingly recognized
syndrome characterized by transient and reversible systolic dysfunction
of the apical and middle segments of the left ventricle. This syndrome
resembles acute myocardial infarction in the absence of evident coronary
artery occlusion. Herein, we present a case of a 51-year old male who
underwent his second deceased-donor renal transplantation for end-stage
renal-disease due to a work-related accident. Perioperatively,
initiation of continuous infusion of noradrenaline was decided to
achieve adequate graft perfusion due to persistently low blood pressure.
On the second postoperative day, the patient experienced tachycardia and
atypical angina-like chest pain. Electrocardiogram (ECG) showed signs of
myocardial infarction and elevated troponin levels were observed. Urgent
coronary angiography was normal and transthoracic echocardiography (TEE)
was indicative for Takotsubo cardiomyopathy.
Discussion. Although, the precise pathophysiology of Takotsubo
cardiomyopathy is still unknown, it seems that it is associated with
excessive sympathetic stimulation, microvascular dysfunction, coronary
artery vasospasm, and abnormal myocardial tissue metabolism. The
development of patient’s symptoms after the initiation of norepinephrine
along with their immediate resolution after the discontinuation of the
drug might suggest a causal relationship. This is the first time that
TCM after renal transplantation is thought to be linked with the
administration of exogenous catecholamines.
Συγγραφείς:
Vailas, M. G.
Vernadakis, S.
Kakavia, K.
Paizis, I. and
Bokos, J.
Boletis, J.
Zavos, G.
Περιοδικό:
Transplantation Proceedings
Εκδότης:
EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC
DOI:
10.1016/j.transproceed.2016.05.014
