A rare case of atypical mid-variant takotsubo cardiomyopathy during dobutamine stress echocardiography (RCD code: III-5B)

Dobutamine stress echo (DSE) allows for a relatively safe and accurate assessment of ischaemia in patients, who are unable to exercise. Side effects of DSE include nausea, vomiting, and in certain cases, excessive rise and fall in blood pressures. However, in the setting of an intrinsic catecholamine surge, dobutamine stress testing can lead to transient ventricular ballooning. Here, we report a case of a 66‑year‑old female who developed chest pain with ST‑segment elevation on electrocardiogram (ECG) along with wall motion abnormalities seen on transthoracic echocardiogram (TTE) during dobutamine stress testing. Her urgent coronary angiogram showed non‑obstructive coronaries with systolic mid‑anterolateral and antero‑septal wall ballooning on left ventriculogram with basal and apical sparing. The ECG changes resolved prior to discharge and cardiac function returned to normal on follow‑up at 3 months. The absence of obstructive coronary lesions with wall motion abnormalities on TTE and left ventriculogram, followed by the return of cardiac function to normal on follow‑up TTE highlights this case as a unique occurrence of a dobutamine‑induced, mid‑ventricular variant, atypical takotsubo cardiomyopathy. To the best of our knowledge, this is the first case of mid variant atypical takotsubo cardiomyopathy occurring secondary to dobutamine administration reported from the Indian subcontinent. The occurrence of this phenomenon points towards an extremely rare effect that may occur as a consequence of stress testing with dobutamine. JRCD 2018; 3 (6): 214–218.