Exercise stress cardiomyopathy—a case report

Background: Stress cardiomyopathy (Takotsubo syndrome) is a characteristically reversible cardiomyopathy with several potential triggers. The condition has been described in the context of stress echocardiography, particularly following the use of pharmacological agents such as dobutamine. The association between Takotsubo syndrome and exercise stress echocardiography is less commonly reported. Case summary: Exercise stress echocardiography was utilized in the investigation of dyspnoea in a 62-year-old female referred to the outpatient cardiology clinic. Inducible regional wall motion abnormalities were identified at peak stress, with associated ECG changes. Subsequent multimodality investigation, including cardiac magnetic resonance imaging, confirmed the diagnosis of stress cardiomyopathy, with coronary angiography revealing only minor coronary artery disease. Serial imaging was crucial in demonstrating complete resolution of the initial abnormalities, supporting the diagnosis. Discussion: Takotsubo syndrome during stress echocardiography is a rare occurrence, with relatively few cases having been described in the context of exercise stress testing. This case demonstrated echocardiographic findings that were similar to major ischaemia. A comprehensive multimodality approach was required to exclude significant coronary artery disease and confirm the diagnosis of exercise stress cardiomyopathy.