Takotsubo cardiomyopathy is a disorder characterized by left ventricular apical ballooning and electrocardiographic changes in the absence of coronary artery disease. While reversible in many cases, the mechanism of this disorder remains unclear. The most frequent clinical symptoms of takotsubo cardiomyopathy on admission are chest pain and dyspnea, resembling acute myocardial infarction. Here, we describe two cases of takotsubo cardiomyopathy without chest pain or dyspnea in patients on maintenance hemodialysis. The asymptomatic nature of these two cases may be due to the patients being on hemodialysis. Periodic electrocardiograms (ECG) may be helpful in screening this population for asymptomatic takotsubo cardiomyopathy and in evaluating its incidence. 1. Introduction Takotsubo cardiomyopathy, derived from the Japanese term for “octopus pot,” is an unusual form of acute cardiomyopathy showing left ventricular apical ballooning with a distinct neck, a shape that mimics traps used to catch octopus, and is often triggered by intense physical or emotional distress [1]. Although maintenance hemodialysis patients usually have either or both extra physical or emotional stress [2], it is noteworthy that cases of takotsubo cardiomyopathy have been rarely reported previously in this population. We describe two cases of takotsubo cardiomyopathy in hemodialysis patients. 2. Case Reports 2.1. Case 1 A 63-year-old female on maintenance hemodialysis was admitted to our hospital for an initial generalized tonic seizure suffered at home. Just after admission, a second generalized tonic seizure was observed. During the seizure, conjugate eye deviation toward the upper left was noted. On admission, her pulse rate was 92 beats/min, blood pressure 134/92？mm？Hg, and body temperature 36.5°C. Neither abnormal heart sounds nor rales were noted on auscultation. Brain computed tomography (CT) and magnetic resonance imaging (MRI) showed no mass lesion, hemorrhage, or infarction (Figures 1(a) and 1(b)). Electroencephalography showed repetition of intermittent high-amplitude irregular slow waves in the right frontal lobe (Figure 1(c)). Based on these findings, the patient was diagnosed with generalized partial seizures. After administration of phenytoin sodium, the seizures resolved, and neurological findings normalized. According to her medical record, she had no history of diabetes mellitus or coronary artery disease, nor any family history of coronary artery disease. She had been stable on maintenance hemodialysis for 32 years, and the appropriate dry weight was maintained.
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