Dobutamine stress echo-induced apical ballooning (Takotsubo) syndrome

We report a case of dobutamine stress echocardiography (DSE) resulting in transient apical ballooning syndrome to highlight this rare condition as a potential complication of DSE. Takotsubo cardiomyopathy, or transient apical ballooning syndrome, is a recently described form of left ventricular (LV) dysfunction induced by stress. Clinically it can mimic acute coronary syndrome in its presentation. It is characterized by an atypical distribution of LV dysynergy with apical ballooning and compensatory basal hyperkinesis. Coronary angiography is normal. It has preponderance in females. Although the aetiology of Takotsubo syndrome remains obscure catecholamine release appears to be the principal trigger. We report a case of dobutamine-induced transient LV apical ballooning in a woman without coronary disease, during a dobutamine stress echocardiogram. There was evidence of ventricular recovery by 72 h. To our knowledge, only three other case reports describe dobutamine-induced Takotsubo cardiomyopathy. Dobutamine stress echocardiography is a widely performed diagnostic test, however, it can rarely result in presumed catecholamine-induced transient apical ballooning syndrome.