Key result
Dobutamine infusion induced transmural myocardial ischemia in a patient with mild coronary lesions, likely by producing occlusive coronary spasm.
Why the study?
Can dobutamine induce transmural myocardial ischemia in patients with mild coronary lesions?
Case Report (n=1)
Can dobutamine induce transmural myocardial ischemia in patients with mild coronary lesions?
Dobutamine stress testing may induce transmural myocardial ischemia in patients with mild coronary lesions, likely due to occlusive coronary spasm on a substrate of endothelial dysfunction.
Clinicians should consider spasm risk with dobutamine even in mild lesions; this case leaves open broader testing implications.
A 70-year-old man was admitted for evaluation of retrosternal pain at rest. During infusion of dobutamine (25 micrograms/kg/min) the patient developed angina, ST-segment elevation in the inferior leads, and echocardiographic hypokinesia in the inferior-basal myocardial wall. Coronary angiography revealed insignificant (20-30%) stenosis of the right coronary artery and a normal remaining tree. This case suggests that dobutamine may induce transmural myocardial ischemia in patients with mild coronary lesions, probably by producing occlusive coronary spasm on a substrate of arterial endothelial dysfunction.
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Kardaras et al. (1996) conducted a case report in Retrosternal pain at rest with mild coronary lesions (n=1). Dobutamine was evaluated on Transmural myocardial ischemia (angina, ST-segment elevation, and echocardiographic hypokinesia). Dobutamine infusion induced transmural myocardial ischemia in a patient with mild coronary lesions, likely by producing occlusive coronary spasm.
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