title: Dobutamine stress echocardiography unmasks acute worsening of mitral regurgitation with latent left ventricular outflow tract obstruction behind diastolic heart failure in hypertensive heart disease.
abstract: In a 57-year-old woman who was referred as refractory diastolic heart failure, dobutamine stress echocardiography facilitated the diagnosis of acute worsening of mitral regurgitation accompanied with latent left ventricular outflow tract obstruction as a cause of recurrent flash pulmonary edema. Echocardiography revealed the presence of sigmoid septum and concentric left ventricular hypertrophy, being consistent with hypertensive heart disease. Dobutamine induced systolic anterior motion of the mitral valve (SAM) with massive mitral regurgitation, resulting in sudden hypotension with dyspnea. The class Ia antiarrhythmic drug, cibenzoline, reduced the SAM during a dobutamine stress test, followed by no recurrence of flash pulmonary edema.
authors.affiliation: Cardiovascular Division of Medicine, National Cardiovascular Center, Suita, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Fujino
authors.forename: Hideaki
authors.initials: H
authors.lastname: Kanzaki
authors.forename: Jun
authors.initials: J
authors.lastname: Tanaka
authors.forename: Takahiro
authors.initials: T
authors.lastname: Ohara
authors.forename: Jiyoong
authors.initials: J
authors.lastname: Kim
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Hashimura
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nakatani
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Ikeda
authors.forename: Hatsue
authors.initials: H
authors.lastname: Ueda-Ishibashi
authors.forename: Masafumi
authors.initials: M
authors.lastname: Kitakaze
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D004280:Dobutamine; D025401:Echocardiography, Stress; D004562:Electrocardiography; D005260:Female; D054144:Heart Failure, Diastolic / Q000150:complications / Q000000981:diagnostic imaging*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000000981:diagnostic imaging*; D007093:Imidazoles / Q000627:therapeutic use; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy; D011654:Pulmonary Edema / Q000188:drug therapy / Q000209:etiology; D014694:Ventricular Outflow Obstruction / Q000150:complications / Q000000981:diagnostic imaging*
chemical_list: D000889:Anti-Arrhythmia Agents; D007093:Imidazoles; D004280:Dobutamine; C032151:cifenline