2Department of Internal Medicine, Hazrat-e Rasool General Hospital, Iran University of Medical Sciences; Tehran-Iran
3Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Science; Tehran-Iran
4Department of Medicine, Clinical Pharmacology, Vanderbilt University Medical Center; Nashville, TN-USA
Abstract
Takotsubo cardiomyopathy (TCM) is a rare syndrome that precipitates by any physiologic, pathologic, or pharmacologic increase in catecholamine secretion. Here, we report a case of TCM after dobutamine stress echocardiography along with a systematical review of similar studies. After discussing our case, we searched articles for dobutamine stress echocardiography-induced TCM and have gathered and reported basic and clinical characteristics from each study. We identified 22 patients. The mean age of presentation was 64.86±11.64 years, with strong female predominance (n=19). The most common type of TCM was apical type; however, patients younger than 55 years were more likely to have inverted type (n=2) or midventricular type (n=1) and mostly presented with chest pain (n=13), following by asymptomatic cases (n=6). Of all, 16 patients developed symptoms during the intervention while consuming a dobutamine dose of 30–40 mcg/kg/min and three developed during the recovery period. The mean cardiac troponin I level was 2.68±2.70 ng/dL, and the most common finding on electrocardiogram was ST segment elevation (n=15). A complete resolution of any wall motion abnormality was achieved (n = 20), except for a near complete resolution in one patient and death of one patient. TCM should be considered in patients developing ECG change and apical ballooning after dobutamine stress echocardiography. TCM is similar to the classic type, but it can be present even without any symptoms and can occur even in the recovery phase of the test.