PMC4783539_01
Initial transthoracic echocardiogram in the acute setting revealing features suggestive of stress cardiomyopathy. Systolic (a) and diastolic (b) apical 4-chamber views reveal akinetic apical and mid-anteroseptal segments (arrowheads) with hyperdynamic middle segments. Systolic (c) and diastolic (d) apical 2-chamber views disclose normal wall motion of the mid-cavity (arrows). The circumferential pattern of left ventricular myocardial dysfunction characterized by symmetric wall motion abnormalities involving the septal, anterior, and lateral walls is highly suggestive of stress cardiomyopathy.
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An urgent transthoracic echocardiogram revealed multiple left ventricular regional wall motion abnormalities, notably akinesis of the mid-distal anteroseptal, mid-distal anterolateral, mid-distal inferoseptal, mid-distal inferolateral, and apical segments (Figure 1).
Mean arterial pressure versus time; graph of mean arterial pressure readings against time with corresponding scheduled doses of diazepam, administration of lorazepam, infusion of dexmedetomidine, and ECG changes. *Infusion started at 11:15 AM. Does not include initial loading dose of 1 mug/kg over 10 minutes.  Infusion stopped at 11:11 AM.
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The mean infusion rate was 0.31 mug/kg/hr, administered over a period of 23.93 hours (Figure 2).
Repeat transthoracic echocardiogram confirming complete recovery of ventricular systolic function and resolution of the acute wall motion abnormalities, supporting the diagnosis of stress cardiomyopathy. Systolic (a) and diastolic (b) apical 4-chamber views and systolic (c) and diastolic (d) apical 2-chamber views reveal normal motion of the ventricular apex (arrows).
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Subsequent echocardiography performed 14 months after the event revealed resolution of the acute regional wall abnormalities and confirmed a full recovery of ventricular systolic function, further supporting the diagnosis of stress cardiomyopathy (Figure 3).