Takotsubo cardiomyopathy following ultrasound-guided renal cyst aspiration.

Dorissa Lahner Gursahaney,Jonathan Lindquist,Dominik M Wiktor

doi:10.1259/bjrcr.20180101

Abstract

Interventional radiology plays a critical role in offering minimally invasive procedures, resulting in increased patient comfort. However, of the millions of patients undergoing interventional procedures each year, many suffer from pre-procedural psychological stressors related to fear of discomfort and diagnostic uncertainty. We describe a case of Takotsubo cardiomyopathy, also called broken heart syndrome or stress cardiomyopathy, following ultrasound-guided renal cyst aspiration in a patient with severe anxiety in anticipation of the interventional radiology procedure.

Highlights

A 48-year-old healthy female with a history of autosomal dominant polycystic kidney disease (ADPKD), premature ventricular contractions, hypertension, hyperlipidaemia, and anxiety presented for elective outpatient right renal cyst aspiration for right upper quadrant abdominal pain secondary to renal capsular stretch
Her family history is pertinent for a father with ADPKD and several myocardial infarctions beginning in his forties
Takotsubo cardiomyopathy (TTC) is a transient, acute cardiomyopathy characterized by left ventricular wall motion abnormalities in the absence of coronary artery occlusion.[1,2]

Summary

Case presentation

A 48-year-old healthy female with a history of autosomal dominant polycystic kidney disease (ADPKD), premature ventricular contractions, hypertension, hyperlipidaemia, and anxiety presented for elective outpatient right renal cyst aspiration for right upper quadrant abdominal pain secondary to renal capsular stretch Her family history is pertinent for a father with ADPKD and several myocardial infarctions beginning in his forties. Discussions with the patient and her family at bedside revealed that she suffers from anxiety at baseline and experienced severe anxiety regarding the renal cyst aspiration for several weeks prior to the procedure. Differential diagnosis Abdominal pain and haemodynamic instability following renal intervention is most suspicious for post-procedural haemorrhage, in a patient with a history of hypertension.

Discussion

Learning points