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Takotsubo syndrome: case report A 75-year-old woman developed Takotsubo syndrome while undergoing stress echocardiography with atropine and dobutamine. The woman, who was undergoing outpatient follow-up due to atypical chest pain, was referred for stress echocardiography with dobutamine. She had a history of chronic kidney disease, dyslipidaemia, hypertension, obesity and hyperthyroidism. Her medications included carvedilol, enalapril and simvastatin. During the resting echocardiogram, she had a preserved systolic function with left ventricle ejection fraction of 56%, without changes in segmental mobility. After receiving dobutamine 20 µg/kg/min and infusion of atropine 0.25 mg [routes not stated] for stress echocardiography, she reached an HR of 148 bpm, which was 102% of the maximum expected for her age. At peak stress, she developed nausea, hypotension and left ventricular systolic dysfunction with ejection fraction estimated at 30%, at the cost of apical akinesia and hypokinesia of the other walls. An ECG revealed ST-segment depression of the inferior wall. Thus, the woman’s examination (stress echocardiography) was interrupted. During the recovery stage, there was an improvement of symptoms with partial recovery of systolic function with ejection fraction at 40%. However, apical hypokinesia and a discreet ST-segment elevation in the inferior wall remained. Thus, she was referred to the emergency department. On admission, she had a BP of 100×50mm Hg and HR of 80 bpm, and respiratory and heart auscultation showed no changes. On admission, the ECG in the emergency department showed no acute ischaemic changes in the sinus rhythm. The markers of myocardial necrosis were positive with troponin-I at 1.19 ng/mL. On the same day, she underwent cardiac catheterisation, which showed coronary arteries without obstructive lesions, and ventriculography showing apical ballooning akinesis. Thus, a diagnosis of the typical pattern of Takotsubo syndrome secondary to pharmacological stress with dobutamine and atropine was made [times to reaction onset not stated]. Her clinical therapy with carvedilol and enalapril was maintained, and she underwent cardiovascular magnetic resonance, which revealed a slightly reduced global systolic function of the left ventricle with an ejection fraction of 46%, at the cost of diffuse hypokinesia, which was more accentuated in the apical portion. The result validated previous examinations, demonstrating findings compatible with Takotsubo syndrome. She progressed uneventfully and was discharged after 8 days of hospitalisation. Mangolini VI, et al. Dobutamine-induced Takotsubo syndrome during stress echocardiogram - An unusual but potentially severe association. Revista da Associacao Medica 803504682 Brasileira (1992) 66: 724-727, No. 6, Jun 2020. Available from: URL: http://doi.org/10.1590/1806-9282.66.6.724

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