Coronary artery spasm during dobutamine stress echocardiography in a patient with angiographically normal coronary arteries

Ferreira, L.D.C.; Gil, M.A.án.; Monaco, C.G.; Silva, C.E.S.; Peixoto, L.B.; Ortiz, J.

Revista Portuguesa de Cardiologia Orgao Oficial da Sociedade Portuguesa de Cardiologia 23(3): 389-395

2004


ISSN/ISBN: 0870-2551
PMID: 15185564
Document Number: 8615
Dobutamine stress echocardiography (DSE) has been extensively used for diagnostic and prognostic purposes in patients with suspected or known coronary artery disease. During DSE transitory alterations of myocardial wall mobility can occur in the absence of electrocardiographic alterations, or they can be associated with ST segment depression or even elevation on the electrocardiogram. ST segment elevation during DSE has been reported as an infrequent event, generally associated with previous myocardial infarction or coronary artery disease with critical lesions, since the positive inotropic and chronotropic effects of dobutamine produce an increase in myocardial oxygen demand, causing ischemia and segmental contractility abnormalities in patients with significant coronary stenosis. The present case relates to a patient referred for DSE after an ischemic treadmill exercise test. During DSE she presented ST segment elevation associated with chest pain. Subsequent coronary arteriography showed normal coronary arteries. We speculate that coronary spasm may have occurred in this patient, as a paradoxical response to the dobutamine-induced increase in coronary flow.

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Coronary artery spasm during dobutamine stress echocardiography in a patient with angiographically normal coronary arteries