Stress Cardiomyopathy After Intravenous Administration of Catecholamines and Beta-Receptor Agonists
Jacob Abraham, MD*,
James O. Mudd, MD*,
Navin Kapur, MD ,
Kelly Klein*,
Hunter C. Champion, MD, PhD* and
Ilan S. Wittstein, MD*,*
* Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Division of Cardiology, Tufts Medical Center, Boston, Massachusetts
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Figure 1 Acute Onset of Stress Cardiomyopathy During Dobutamine Stress Echocardiography
Standard transthoracic views obtained during a dobutamine stress echocardiogram at baseline (A), peak dobutamine infusion (B), and post-dobutamine infusion (C) in Patient #1. The views demonstrated in all 3 panels include parasternal long-axis (top left), short-axis (top right), apical 4-chamber (bottom left), and apical 2-chamber (bottom right). Baseline images (A) show normal left ventricular systolic function. At peak dobutamine infusion (B), there is severe mid-ventricular and apical hypokinesis that persists into recovery (C). Cardiac catheterization 2 days later revealed normal coronary arteries and recovery of left ventricular systolic function. Also see accompanying Online Videos 1, 2, and 3.
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Figure 2 Electrocardiograms Associated With the 3 Ballooning Variants of Stress Cardiomyopathy After Drug Administration
T-wave inversion, Q waves, and corrected QT interval (QTc interval) prolongation were seen with the apical variant (A). Nonspecific T-wave abnormalities were seen with the midventricular variant (B). Broad upright T waves and QTc interval prolongation were characteristic of the basal variant (C). These electrocardiogram patterns evolved within 24 to 48 h of drug administration.
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Figure 3 Ventricular Ballooning Variants in Stress Cardiomyopathy After Drug Administration
Two-dimensional echocardiogram of a patient with the apical ballooning variant (left). Contrast ventriculography of patients with the midventricular variant (middle) and the basal ballooning variant (right). Diastole (top) and systole (bottom) in all panels.
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Video 1
Video Acute Onset of Stress Cardiomyopathy During Dobutamine Stress Echocardiography
Standard transthoracic views obtained during a dobutamine stress echocardiogram at baseline (Video 1), peak dobutamine infusion (Video 2), and post-dobutamine infusion (Video 3) in patient #1. The views demonstrated in all 3 videos include parasternal long-axis (top left), short-axis (top right), apical 4-chamber (bottom left), and apical 2-chamber (bottom right). Baseline images (Video 1) show normal left ventricular systolic function. At peak dobutamine infusion (Video 2), there is severe mid-ventricular and apical hypokinesis that persists into recovery (Video 3). Cardiac catheterization 2 days later revealed normal coronary arteries and recovery of left ventricular systolic function.
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