title: Mid-Ventricular Variant of Dobutamine-Induced Stress Cardiomyopathy.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
authors.affiliation: Division of Cardiology, Creighton University School of Medicine, Omaha, Nebraska, USA.
authors.forename: Satish
authors.initials: S
authors.lastname: Chandraprakasam
authors.affiliation: Division of Cardiology, Creighton University School of Medicine, Omaha, Nebraska, USA.
authors.forename: Swapna
authors.initials: S
authors.lastname: Kanuri
authors.affiliation: Division of Cardiology, Creighton University School of Medicine, Omaha, Nebraska, USA.
authors.forename: Claire
authors.initials: C
authors.lastname: Hunter
keywords: Cardiomyopathy; Echocardiography, Stress; Takotsubo Cardiomyopathy