Reverse Takotsubo pattern stress cardiomyopathy in a male patient induced during dobutamine stress echocardiography.

Case Presentation A 53-year-old Chinese male underwent dobutamine stress echocardiography for evaluation of chest pain. He had a background history of previously treated pulmonary tuberculosis and depression. Baseline left ventricular ejection fraction (LVEF) was normal. At peak intravenous dobutamine infusion of 40 mcg/kg/min, he developed retrosternal chest tightness and his systolic blood pressure rose to 235/135 mmHg. The left ventricular cavity became dilated and the LVEF dropped to 20%. Electrocardiography did not show any ST segment elevation. Urgent coronary angiography revealed minor coronary artery disease. Left ventriculogram showed apical hyperkinesis and basal akinesis, a pattern reverse that of Takotsubo cardiomyopathy (Fig. 1). There was no appreciable rise in his serial serum cardiac enzyme levels. The patient’s symptoms gradually resolved. He was prescribed aspirin, simvastatin, bisoprolol and enalapril. Repeat echocardiography 2 weeks later revealed normal LVEF with no segmental wall motion abnormality.