Coronary artery spasm following dobutamine stress echocardiogram

Abstract

A 53-year-old woman with atypical chest pain underwent a dobutamine stress echocardiogram (DSE) and developed a coronary spasm (CS) with severe pain and dramatic ST-segment elevation 9 min after dobutamine infusion was discontinued. The spasm resolved after sublingual nitroglycerin administration. The same-day coronary angiogram showed non-significant stenosis in the three coronary territories. Retrospectively, we found that the patient had vasospastic angina (VSA), a condition that has been strongly associated with the development of dobutamine-induced CS. Mechanisms of dobutamine-induced CS are not fully understood and include endothelial dysfunction leading to deficient nitric oxide-mediated coronary vasodilation in response to increased myocardial oxygen demand as well as imbalance between β1 and β2 adrenergic effects of dobutamine. Dobutamine-induced CS has also been much more frequently reported in patients from Asian descent with VSA. VSA should be systemically recognised in patients considered for DSE and, if present, other modalities of stress imaging should be discussed.

ATP Stress Myocardial Contrast Echocardiography Assessment of Coronary Microvascular Disease with Spasmodic Characteristics: A Case Report

“…[9,10] The main factors contributing to vasospasm are smoking, alcohol consumption, vascular endothelial damage, excessive smooth muscle cell contraction, disordered autonomic nervous regulation, and inflammation, among others. [11,12] The patient presented here had risk factors (smoking and alcohol consumption), as well as ultrasound manifestations in the recovery period closely related to coronary microvascular spasm. Furthermore, ATP-induced coronary microvascular spasm was limited to segmental left ventricular wall myocardial perfusion delay, which was inconsistent with the distribution area of the epicardial coronary artery, [9] and with the decreased blood flow velocity in the distal part of the epicardial coronary spasm.…”

ATP stress MCE in evaluating coronary microvascular spasm: a case report

“…It had been reported that ATP stress induced coronary vasospasm, but the exact mechanism of ATP induced coronary microvascular spasm was not clear, which might be related to the damage of vascular endothelial cells, the decrease of endothelium-dependent relaxation and the enhancement of reactive contraction [6][7] . The factors leading to vasospasm mainly included smoking, drinking, damage to vascular endothelium, excessive contraction of smooth muscle cells, autonomic nerve regulation disorder and inflammation [8][9] . This patient also had risk factors of smoking and drinking.…”

The value of ATP stress MCE in evaluating myocardial microvascular spasm -- a case report 1

“…Cases of ATP-induced coronary vasospasm have been reported, but the exact mechanism of ATP-induced coronary vasospasm was not clear, which could be related to the damage of vascular endothelial cells, the decrease of endothelium-dependent relaxation and the enhancement of reactive contraction [5][6] . The factors leading to vasospasm mainly included smoking, drinking, damage to vascular endothelium, excessive contraction of smooth muscle cells, autonomic nerve regulation disorder , inflammation and so on [7][8] . This patient also had risk factors of smoking and drinking.…”