Chandraprakasam Satish, Kanuri Swapna, Hunter Claire
Division of Cardiology, Creighton University School of Medicine, Omaha, Nebraska, USA.
Res Cardiovasc Med. 2015 May 23;4(2):e25223. doi: 10.5812/cardiovascmed.4(2)2015.25223. eCollection 2015 May.
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.
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.
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.
多巴酚丁胺负荷试验是检测和评估冠心病（CAD）预后的常用方法。尽管大多数患者对其耐受性良好，但仍有不良事件的报道。在无阻塞性CAD的情况下，偶尔会出现短暂的室壁运动异常，提示应激性心肌病。
我们报告一名48岁间歇性胸痛女性。她的体格检查、心肌酶和经胸超声心动图均无异常。她接受了多巴酚丁胺负荷超声心动图检查以排除阻塞性CAD。在给予40微克（mcg）/千克/分钟的多巴酚丁胺和0.5毫克阿托品后，她主诉剧烈胸痛并出现高血压。负荷超声心动图显示前壁中部和室间隔中部运动减弱。急诊冠状动脉造影显示冠状动脉正常。右前斜位左心室造影显示收缩期心室中部呈气球样扩张，心尖和心底收缩增强。患者经保守治疗后恢复良好。
多巴酚丁胺诱导的应激性心肌病中间型的机制尚不清楚。我们认为其涉及多种机制，对于合并精神疾病和使用中枢性兴奋剂的患者应考虑这种风险。
