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Cardiac Stress Test Induced by Dobutamine and Monitored by Cardiac Catheterization in Mice
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Dobutamine-induced ST segment elevation in a patient with angina at rest and critical coronary lesions

M Previtali1, L Lanzarini, A Mussini

  • 1Division of Cardiology, IRCCS-Policlinico S. Matteo, Pavia, Italy.

European Heart Journal
|July 1, 1992
PubMed

Insights

Dobutamine can cause ST-segment elevation and myocardial ischemia in patients with severe coronary artery disease. This chest pain resolved with propranolol, highlighting a potential risk of dobutamine in specific cardiac conditions.

Area of Science:

  • Cardiology
  • Clinical Medicine
  • Pharmacology

Background:

  • Dobutamine is a common inotropic agent used in managing heart failure and cardiogenic shock.
  • Severe coronary artery disease (CAD) presents significant challenges in cardiovascular pharmacotherapy.
  • Understanding drug-induced ischemia is crucial for patient safety.

Observation:

  • A patient with severe two-vessel coronary artery disease experienced ST-segment elevation and angina at rest.
  • Coronary angiography during the ischemic episode revealed patent coronary arteries.
  • Symptoms and electrocardiographic changes resolved following administration of propranolol.

Findings:

  • Dobutamine administration precipitated transmural myocardial ischemia, evidenced by ST-segment elevation.
  • The ischemia was associated with increased myocardial oxygen demand and maldistribution of myocardial blood flow.
  • Propranolol effectively reversed the dobutamine-induced ischemic effects.

Implications:

  • Dobutamine should be used with caution in patients with severe coronary lesions due to the risk of inducing myocardial ischemia.
  • This case underscores the importance of considering drug-induced ischemia in patients presenting with angina and known severe CAD.
  • Pharmacological interventions targeting myocardial oxygen balance are critical in managing such adverse events.

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