Dobutamine stress echocardiography unmasks acute worsening of mitral regurgitation with latent left ventricular outflow tract obstruction behind diastolic heart failure in hypertensive heart disease.
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.
Fujino
Masashi
M
Cardiovascular Division of Medicine, National Cardiovascular Center, Suita, Japan.
Kanzaki
Hideaki
H
Tanaka
Jun
J
Ohara
Takahiro
T
Kim
Jiyoong
J
Hashimura
Kazuhiko
K
Nakatani
Satoshi
S
Ikeda
Yoshihiko
Y
Ueda-Ishibashi
Hatsue
H
Kitakaze
Masafumi
M
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*
D000889:Anti-Arrhythmia Agents; D007093:Imidazoles; D004280:Dobutamine; C032151:cifenline