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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor&#44; </span></p><p class="elsevierStylePara">Tako-Tsubo syndrome&#44; stress cardiopathy or transient apical ballooning&#44; is a very rare clinical condition&#44; and consists of a reversible acute heart failure&#46; It is common in middle-aged women&#44; following intense periods of psychological or physical stress&#46;<span class="elsevierStyleSup">1</span></p><p class="elsevierStylePara">As described in the nineties&#44; it consists of an acquired myocardiopathy that simulates all clinical&#44; analytical&#44; electrocardiographic and echocardiographic aspects of an acute&#44; usually apical&#44; attack&#46;<span class="elsevierStyleSup">2</span> It is usually presented as an acute heart failure&#44; with typical or atypical chest pain&#46; It also presents with TS segment alterations and&#47;or repolarisation on the electrocardiogram &#40;ECG&#41; and positive troponin curve&#46; The electrocardiogram shows a severe myocardial dysfunction with a reduced ejection fraction&#46; However&#44; studies for detecting coronary ischaemia &#40;stress ergometry or coronary angiography&#41; are&#44; by definition&#44; negative&#46;<span class="elsevierStyleSup">3</span></p><p class="elsevierStylePara">The most accepted histopathological theories discuss transient microvascular spasms caused by catecholaminergic discharge in predisposed patients&#46; More recent studies champion a neurocardiogenic theory&#46;<span class="elsevierStyleSup">4</span></p><p class="elsevierStylePara">Prognosis is almost always benign&#44; with complete myocardial function recovery&#44; and the relapse rate is between 2&#37; and 10&#37;&#46;<span class="elsevierStyleSup">5</span></p><p class="elsevierStylePara">As with all acute heart disorders&#44; Tako-Tsubo syndrome can induce acute or chronic renal failure through the classic mechanisms of secondary kidney involvement&#46; We describe the case of a partially recovered acute kidney failure after resolving the heart disorder&#46;</p><p class="elsevierStylePara">The patient is a 51-year-old female&#44; smoker&#44; with no relevant history of events&#46; She came to the hospital in March 2010 with clinical symptoms of oedemas in her lower limbs that had developed over a month&#46; She did not have dyspnoea&#44; chest pain or any other symptoms&#46; The emergency department found that she had renal function deterioration with 1&#46;54mg&#47;dl creatinine &#40;baseline creatinine 1&#46;1mg&#47;dl&#41; and microalbuminuria &#40;95mg&#47;day&#41;&#46; The rest of the analyses were within the normal range and the ECG showed negative T waves for leads V5 and V6&#46;</p><p class="elsevierStylePara">She was admitted for examination&#59; the most noticeable result was from a transthoracic echocardiogram that revealed a severely depressed systolic function &#40;ejection fraction of the left ventricle of 25&#37;&#41;&#44; with overall hypokinesia and slight hyperechogenicity of the ventricular wall &#40;Figure 1&#41;&#46; The other complementary tests were negative&#46; The abdominal ultrasound found small kidneys &#40;10cm and 11cm&#41; with good corticomedullary differentiation &#40;Figure 2&#41;&#46;</p><p class="elsevierStylePara">Two weeks later&#44; cardiac magnetic resonance imaging was performed showing that the ventricular function and heart contractility were normal&#46; A subcutaneous fat biopsy was performed to verify possible amyloidosis&#44; which was also negative&#46; Stress ergometry performed three months later was negative for myocardial ischaemia&#46;</p><p class="elsevierStylePara">In view of this&#44; the patient was diagnosed with transient myocardial dyskinesia&#46; Performing the ventriculography was not considered given that she had good myocardial recovery&#44; and so as to not worsen the kidney failure&#46; When the doctor spoke to her again&#44; she mentioned that her family situation had been extremely stressful days before her symptoms started&#46;</p><p class="elsevierStylePara">After the renal function reached a maximum creatinine level of 2mg&#47;dl&#44; it started to improve&#46; It was 1&#46;4mg&#47;dl in the last examination performed in the nephrology department&#46; Furthermore&#44; ventricular function continued to be normal in later ultrasound scans&#46;</p><p class="elsevierStylePara">This is a representative case of a type 1 cardiorenal syndrome &#40;kidney involvement secondary to acute heart failure&#41; in the context of a recently reported complex pathology&#44; such as the Tako-Tsubo syndrome&#46; It is a prerenal failure&#44; in which an adequate recovery of renal function should be expected&#46;</p><p class="elsevierStylePara">While there are no good early markers available for kidney dysfunction&#44; renal function must be closely monitored for any patient with an acute heart disease for an early diagnosis&#46; If the cardiologist and the nephrologist work together in acute management of the treatment&#44; patient prognosis could improve&#46;</p><p class="elsevierStylePara"><a href="grande&#47;10879&#95;108&#95;19854&#95;en&#95;10879&#95;f1&#46;jpg" class="elsevierStyleCrossRefs"><img src="10879_108_19854_en_10879_f1.jpg" alt="Transthoracic echocardiogram"></img></a></p><p class="elsevierStylePara">Figure 1&#46; Transthoracic echocardiogram</p><p class="elsevierStylePara"><a href="grande&#47;10879&#95;108&#95;19855&#95;en&#95;10879&#95;f2&#46;jpg" class="elsevierStyleCrossRefs"><img src="10879_108_19855_en_10879_f2.jpg" alt="Kidney ultrasound"></img></a></p><p class="elsevierStylePara">Figure 2&#46; Kidney ultrasound</p>"
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