Vasoespasmo coronariano induzido pela ecocardiografia sob estresse pela dobutamina-atropina

Abstract

This is the report on a 45-year-old female, with a history of systemic arterial hypertension and cigarette smoking, submitted to dobutamine-atropine stress echocardiography for the investigation of coronary artery disease. At stress peak, the patient reported sudden, highly intense precordial pain. The 12-lead electrocardiogram showed ST segment elevation in DII, DIII, aVF, V5 and V6, and depression in DI, aVL, V2 and V3. Echocardiographic imaging monitoring showed dyskinesia of inferior septum and akinesia of inferior wall. The test was interrupted immediately. The patient was medicated and improved her precordial pain condition as well as wall motion abnormalities. Coronary angiography showed irregular coronary lesions with <50% luminal diameter obstruction. It is a case of coronary spasm induced by alpha-adrenergic stimulation during dobutamine-atropine stress echocardiography.

Chronotropic Incompetence in Diabetic Elderly on Echocardiography

“…When chronotropic deficit is observed on pharmacological stress echocardiography, a relationship is observed with neither prognosis nor prevalence of coronary artery disease, but with sinus node disorders, extrasystoles or dysautonomia, which might be due to dobutamine effects 2,3 . We would like to know whether, in those authors' opinion, the chronotropic deficit can play any prognostic role in pharmacological stress echocardiography.…”

A enfermeira no cuidado aos pacientes submetidos ao eco-stress farmacológico: implicações para a prática clínica

“…Entretanto, muitas vezes, pode estar associada a outras causas tais como a esofagite de refluxo, hérnia de hiato, espasmo esofagiano, ansiedade, doença de origem pulmonar, pericardite, compressões de raízes nervosas, doença de natureza musculoesquelética, ou ainda, relacionada à disfunção de órgãos abdominais (12,13) . Além disto, existem outras condições em que a dor torácica pode estar presente, ser de origem cardíaca, mas sem lesão coronária: angina vasoespástica (14) ou microvascular (denominada síndrome X), prolapso da valva mitral e miocardites agudas. Nas condições provocadas pela alteração na relação entre a oferta e a demanda de oxigênio pelo miocárdio se incluem, ainda a estenose valvar aórtica, cardiomiopatia hipertrófica, intoxicação por cocaína (15) , miocardiopatia dilatada e taquiarritmias (1) .…”