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

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Measurement of Myocardial Lactate Production for Diagnosis of Coronary Microvascular Spasm
06:18

Measurement of Myocardial Lactate Production for Diagnosis of Coronary Microvascular Spasm

Published on: September 17, 2021

Luiz Darcy Cortez Ferreira1, Manuel Adán Gil, Claudia Gianini Monaco

  • 1OMNI-CCNI Medicina Diagnóstica São Paulo, Brasil.

Revista Portuguesa De Cardiologia : Orgao Oficial Da Sociedade Portuguesa De Cardiologia = Portuguese Journal of Cardiology : an Official Journal of the Portuguese Society of Cardiology
|June 10, 2004
PubMed

Insights

Dobutamine stress echocardiography can rarely cause ST segment elevation, even with normal coronary arteries. This case suggests coronary artery spasm as a potential cause.

Area of Science:

  • Cardiology
  • Diagnostic Imaging
  • Clinical Medicine

Background:

  • Dobutamine stress echocardiography (DSE) is a key tool for assessing coronary artery disease.
  • ST segment elevation during DSE is uncommon, typically linked to severe coronary stenosis or prior myocardial infarction.
  • Dobutamine increases myocardial oxygen demand, potentially causing ischemia.

Observation:

  • A patient undergoing DSE after an ischemic treadmill test experienced ST segment elevation and chest pain.
  • Coronary arteriography revealed normal coronary arteries, ruling out significant stenosis.

Findings:

  • The observed ST segment elevation during DSE, despite normal coronary arteries, is an infrequent event.
  • This presentation challenges the typical association of ST elevation with critical coronary lesions.

Implications:

  • Coronary artery spasm is hypothesized as a possible mechanism for dobutamine-induced ST elevation in this case.
  • This finding may broaden the differential diagnosis for ST elevation during stress testing.
  • Further investigation into vasospastic responses to dobutamine is warranted.

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