Reproducible microvascular dysfunction with dobutamine infusion in Takotsubo cardiomyopathy presenting with ST segment elevation.
Takotsubo (ampulla) cardiomyopathy, or broken heart syndrome, is an underrecognized cardiac illness that usually presents as an acute coronary syndrome in postmenopausal females. The disorder is frequently associated with episodes of mental or physical stress, implicating an abnormal cardiac response to increased catecholamines. Although death has been reported during the index event, the long-term prognosis is good with full recovery of left ventricular function. We present a case of Takotsubo cardiomyopathy mimicking anterior ST segment elevation myocardial infarction precipitated by dobutamine stress testing. Reinfusion of dobutamine in the catheterization laboratory reproduced symptoms with angiography and intravascular ultrasound supporting the theory of abnormal microvascular circulation as the etiology of Takotsubo cardiomyopathy. Acute and delayed magnetic resonance imaging demonstrated no infarction with complete recovery of ventricular function.
Brewington
Stacy D
SD
Division of Cardiology, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
Abbas
Amr A
AA
Dixon
Simon R
SR
Grines
Cindy L
CL
O'Neill
William W
WW
D000368:Aged; D001783:Blood Flow Velocity; D009202:Cardiomyopathies / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology*; D002316:Cardiotonic Agents; D017023:Coronary Angiography; D003326:Coronary Circulation; D023921:Coronary Stenosis / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D003937:Diagnosis, Differential; D004280:Dobutamine; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006329:Heart Conduction System / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D007262:Infusions, Intravenous; D008279:Magnetic Resonance Imaging; D009200:Myocardial Contraction; D009203:Myocardial Infarction / Q000175:diagnosis / Q000503:physiopathology; D018084:Ultrasonography, Interventional; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology
D002316:Cardiotonic Agents; D004280:Dobutamine