Images in Cardiovascular Medicine Dobutamine-Precipitated Takotsubo Cardiomyopathy Mimicking Acute Myocardial Infarction A Multimodality Image Approach

shedeveloped typical chest pain with ST-segment elevation inDI, DII, and the anterior leads with ventricular bigeminy(Figure 1B and 1C). The echocardiogram showed apical andmid-wall myocardial segment akinesis with basal hyperkine-sis and left outflow tract gradient obstruction of 60 mm Hg.The ejection fraction was estimated to be 34%, and severemitral regurgitation was found with no organic valvulardisease (Figure 2 and Movie I in the online-only DataSupplement). Troponin I, creatinine kinase, and brain natri-uretic peptide levels were 2.4 ng/dL (normal value, 0.04ng/dL), 80 mg/dL (within normal range), and 928 pg/dL,respectively.Emergent cardiac catheterization showed mild stenosis inthe left anterior descending coronary artery with no signs ofplaque rupture while the patient was still having chest painand ST elevation. Left ventriculography displayed hyperdy-namic basal myocardial segments with cavity obliteration andapical akinesis (Figure 3 and Movie II in the online-only DataSupplement).Cardiac magnetic resonance depicted findings similar tothe echocardiogram with no late gadolinium enhancement(Figure 4 and Movie III in the online-only Data Supplement).The rest single-photon emission computed tomographysestamibi revealed a great perfusion defect that extendedbeyond the left anterior descending coronary artery territory(Figure 5A).The patient made favorable progress and was dischargedwith -blockers, aspirin, and simvastatin. Repeated echocar-diography after 7 days demonstrated normal left ventricularwall motion, the ejection fraction was 55% (Figure 6 andMovie IV in the online-only Data Supplement), and single-photon emission computed tomography 3 months latershowed normal perfusion (Figure 5B).Dobutamine-precipitated takotsubo cardiomyopathy is anunusual presentation of this disease,