Mid-ventricular variant of dobutamine-induced stress cardiomyopathy

Abstract

Introduction:Dobutamine stress testing is a commonly used modality in detecting and estimating the prognosis in coronary artery disease (CAD). Although it is well tolerated by most patients, adverse events have been reported. Rarely, transient wall motion abnormalities can occur in the absence of obstructive CAD to suggest stress cardiomyopathy.Case Presentation:We report a 48-year-old female with intermittent chest pain. Her physical exam, cardiac enzymes and transthoracic echocardiogram were unremarkable. She underwent dobutamine stress echocardiogram to rule out obstructive CAD. After 40 micrograms (mcg)/kg/minute and 0.5 mg atropine, she complained of intense chest pain and became hypertensive. Stress echocardiogram demonstrated mid-anterior and mid-septal hypokinesis. Emergent coronary angiogram demonstrated normal coronaries. Left ventricular angiogram in the right anterior oblique projection revealed mid-ventricular ballooning during systole with apical and basal hypercontractility. Patient demonstrated excellent recovery with expectant management.Conclusions:The mechanism of mid-variant of Dobutamine-induced stress cardiomyopathy remains unclear. We think that multiple mechanisms are involved and this risk should be considered in patients with comorbid psychiatric conditions and with use of centrally acting stimulants.

Dobutamine Induced Takotsubo Cardiomyopathy; A Systematic review of the literature and Case report

“…Our review along with previous studies showed that the most common type of wall motion abnormality is apical type, followed by inverted type in patients younger than 55 years (12,13) or midventricular type of cardiomyopathy (14). A recent systematic review demonstrated that patients aged 45 years or less were less likely to have apical variant cardiomyopathy compared with patients aged 45 years or more (15).…”