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Published on: February 10, 2013
Mid-Ventricular Variant of Dobutamine-Induced Stress Cardiomyopathy
Satish Chandraprakasam1, Swapna Kanuri1, Claire Hunter1
1Division of Cardiology, Creighton University School of Medicine, Omaha, Nebraska, USA.
Insights
Dobutamine stress testing can rarely induce stress cardiomyopathy, even with normal coronary arteries. This case highlights a mid-ventricular variant, emphasizing careful patient selection and monitoring during cardiac evaluations.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Pharmacology
Background:
- Dobutamine stress testing is a standard diagnostic tool for coronary artery disease (CAD).
- While generally safe, adverse events including stress cardiomyopathy can occur.
- Transient wall motion abnormalities may manifest without obstructive CAD.
Observation:
- A 48-year-old female presented with chest pain, undergoing dobutamine stress echocardiogram.
- During the test, she developed chest pain, hypertension, and transient mid-ventricular hypokinesis.
- Coronary angiography revealed normal coronary arteries, but left ventricular angiography showed mid-ventricular ballooning.
Findings:
- The patient was diagnosed with a rare mid-ventricular variant of dobutamine-induced stress cardiomyopathy.
- This condition mimicked obstructive CAD but was confirmed to be a functional abnormality.
- The patient recovered well with conservative management.
Implications:
- The precise mechanisms of dobutamine-induced stress cardiomyopathy are not fully understood.
- Consideration of psychiatric comorbidities and stimulant use may be relevant in susceptible patients.
- This case underscores the importance of recognizing non-obstructive causes of wall motion abnormalities during stress testing.
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.
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