Bezold-Jarisch reflex-mediated asystole during dobutamine stress testing: a case report

Area of Science:

• Cardiology
• Physiology

Background:

• The Bezold-Jarisch reflex (BJR) is a parasympathetic response to ventricular mechanoreceptor activation.
• BJR can cause bradycardia, atrioventricular block, or asystole.
• Dobutamine infusion during stress echocardiography can exceptionally trigger BJR, primarily in middle-aged women.

Purpose of the Study:

• To report a case of severe Bezold-Jarisch reflex during dobutamine infusion.
• To contribute to the understanding of dobutamine-induced BJR.

Main Methods:

• Case report of a 61-year-old woman experiencing a sinus pause during dobutamine infusion.
• Echocardiography, cardiac catheterization, and electrophysiologic study were performed.

Main Results:

• A 5.1-second sinus pause occurred during a 20 μg/kg/min dobutamine infusion.
• Immediate recovery followed dobutamine cessation.
• All diagnostic tests, including echocardiography, cardiac catheterization, and electrophysiologic study, were normal.

Conclusions:

• This is the fifth documented case of severe BJR causing asystole during dobutamine infusion.
• The findings support the generally benign nature of dobutamine-induced BJR.
• This case adds to the evidence regarding BJR during dobutamine stress testing.