Provocation of coronary spasm by dobutamine stress echocardiography in a patient with angiographically minimal coronary artery disease

Abstract

Summary: Dobutamine stress echocardiography (DSE) has been widely used for the noninvasive diagnosis of obstructive coronary artery disease. The ST-segment elevation during DSE has been reported as an infrequent event. caused by old mytsardial infarction andor critical coronary nmowings. The patient presented here was a 35-year-old man with a recent history of nonexertional chest pain. He had hypercholesterolemia and a history of heavy smoking as risk factors. The patient developed ST-segment elevation with chest pain during 40 mcg/min dobutamine infusion for the stress echocardiographic examination. Subsequent coronary angiograms revealed only mild coronary atherosclerosis. It is speculated that coronary spasm occurred in this patient as a paradoxical response to increased coronary blood flow with dobutamine administration.

Incidence, Pathophysiology, and Treatment of Complications During Dobutamine-Atropine Stress Echocardiography

“…9 Des observations cliniques ont été publiées. 58,[79][80][81][82][83][84][85][86] Une publication traitant spécifiquement de cette complication est également disponible.…”

Endothelial Function and Coronary Spastic Angina

“…Exercise, dopamine or dobutamine can induce coronary spasm in some patients with coronary spastic angina (45,(55)(56)(57)(58). The stimulation of beta-1 adrenergic receptors causes systemic arterial dilation including the coronary arteries.…”

Evaluation of platelet activation, fibrinolysis, and hemostatic activation during high dose dobutamine stress echocardiography

“…This procedure is generally considered safe and associated with a low risk for ischemic events [6]. Acute myocardial infarction and ST-segment elevation ischemia, though very unlikely complications during DSE, have been reported in a few cases in patients with no or mild coronary artery disease [1,4,5,10,12,13]. The mechanisms of acute coronary thrombosis or ischemia with dobutamine infusion in these patients remain unclear.…”

“…In fact DSE is a very safe procedure with an exceedingly low complication rate of myocardial infarction. It is possible that spasm remains the dominant mechanism of ST segment elevation myocardial infarction in patients with no significant obstructive coronary lesions undergoing DSE [1,4,5,8,10,11,13]. Close monitoring of patients for ST segment elevation during and after a normal DSE is, therefore, strongly advised.…”

“…When symptomatic ischemia occurs, it is generally well tolerated and resolves with terminating the dobutamine infusion and occasionally, the administration of nitrates and beta-blockers [6]. Acute coronary thrombosis and ST segment elevation ischemia have been reported with high dose dobutamine infusion in patients with no or mild obstructive coronary artery disease (CAD) [1,4,5,10,12,13], or at the site of a recently stented coronary artery [7]. Various mechanisms have been proposed including spasm, platelet activation, or plaque rupture with subsequent activation of hemostasis.…”