Why the study?
Severe Bezold-Jarisch reflex resulting in asystole during dobutamine infusion is exceptionally rare and has only been documented in middle-aged women.
This case report highlights that severe Bezold-Jarisch reflex causing asystole can rarely occur during dobutamine stress echocardiography, but appears to have a benign nature with immediate recovery upon cessation.
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Rare dobutamine-induced BJR during stress echo warrants vigilance; extends prior reports but leaves open incidence and prevention.
BACKGROUND: The Bezold-Jarisch reflex (BJR) is a cardioinhibitory parasympathetic response to activation of ventricular mechanoreceptors, which can result in bradycardia, atrioventricular block, or asystole. This phenomenon has been triggered by acute myocardial ischaemia, intra-arterial nitroglycerine use, natriuretic peptides, and with exceptional rarity, in middle-aged women only, by dobutamine infusion during stress echocardiography. CASE SUMMARY: We present the case of a 61-year-old woman who suffered a 5.1-s sinus pause during her 20 μg/kg/min infusion of dobutamine. Recovery was immediate following termination of dobutamine infusion. Concurrent echocardiography was normal, and subsequent cardiac catheterization and electrophysiologic study were normal. DISCUSSION: This is the fifth documented case of a severe BJR causing asystole during dobutamine infusion, which adds to the accumulating evidence supporting the benign nature of the condition.
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Hossain et al. (2020) studied this question.
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