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[Coronary Spasm after Administration of Propranolol during Dobutamine Stress Echocardiography]
Lucía Alvarez1, José Zamorano, Luis Mataix
1Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain.
Insights
Dobutamine stress echocardiography is a safe test for myocardial ischemia. A patient experienced coronary spasm after the test, possibly due to propranolol, highlighting potential drug interactions.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Dobutamine stress echocardiography is increasingly utilized for diagnosing myocardial ischemia.
- The test is generally considered safe and effective for evaluating coronary artery disease.
Observation:
- A 37-year-old man with rest angina and normal coronary arteries underwent dobutamine-atropine stress echocardiography.
- The stress test was negative for ischemia, but chest pain and ST elevation occurred after propranolol administration.
Findings:
- The patient experienced symptoms consistent with coronary spasm following propranolol injection.
- Intravenous nitroglycerin rapidly resolved the chest pain and electrocardiographic abnormalities.
Implications:
- This case suggests a potential for drug-induced coronary spasm following dobutamine stress echocardiography.
- Further investigation into the interaction between beta-blockers like propranolol and stress testing protocols is warranted.
Abstract:
Dobutamine stress echocardiography, a highly useful and safe challenge test for myocardial ischemia, is being used increasingly. We report the case of a 37-year-old man with rest angina, repolarization abnormalities in precordial leads and normal coronary arteries who was referred for dobutamine-atropine stress echocardiography, which was negative for ischemia. However, after testing, upon injection of propranolol, the patient suffered chest pain associated with ST elevation and severe regional systolic abnormalities. After intravenous nitroglycerin administration, chest pain and electrocardiographic abnormalities disappeared quickly, and systolic motion became normal. This complication was interpreted as a coronary spasm. We discuss the causes for the spasm and the role that might have been played by the drugs employed.