Dobutamina e o Takotsubo

Dobutamine-Precipitated Takotsubo Cardiomyopathy Mimicking Acute Myocardial Infarction
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A 77-year-old woman was referred for a dobutamine stress test. She had a prior history of hypertension. Basal ECG was normal (Figure 1A). At 40 μg · kg−1 · min−1 she developed typical chest pain with ST-segment elevation in DI, DII, and the anterior leads with ventricular bigeminy (Figure 1B and 1C). The echocardiogram showed apical and mid-wall myocardial segment akinesis with basal hyperkinesis and left outflow tract gradient obstruction of 60 mm Hg. The ejection fraction was estimated to be 34%, and severe mitral regurgitation was found with no organic valvular disease (Figure 2 and Movie I in the online-only Data Supplement). Troponin I, creatinine kinase, and brain natriuretic peptide levels were 2.4 ng/dL (normal value, <0.04 ng/dL), 80 mg/dL (within normal range), and 928 pg/dL, respectively. . Um caso de Takotsubo muito bem documentado durante o stress com dobutamina. Sem placas significativas ao cateterismo e recuperação total em 7 dias. Lança uma luz sobre a fisiopatologia da doença e do poder da droga inotrópica que usamos à vontade na cardiologia.
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