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High-grade atrioventricular block during dipyridamole stress testing
R L Shammas1, H J DeAntonio, A Movahed
1Department of Medicine, East Carolina University School of Medicine, Greenville, NC 27858.
Insights
Dipyridamole stress testing can diagnose coronary artery disease. A rare side effect of high-grade atrioventricular block was observed, effectively treated with aminophylline.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Dipyridamole stress testing is a valuable tool for diagnosing coronary artery disease in patients unable to exercise.
- While generally safe, dipyridamole perfusion imaging can rarely cause serious adverse events.
Observation:
- A case of dipyridamole-induced high-grade atrioventricular (AV) block is presented.
- The patient experienced a significant cardiac conduction abnormality during the stress test.
Findings:
- High-grade AV block occurred as a rare complication of dipyridamole administration.
- Intravenous aminophylline rapidly reversed the AV block.
- Atropine was ineffective in treating the induced AV block.
Implications:
- This case highlights a rare but serious side effect of dipyridamole stress testing.
- Aminophylline should be considered as a potential antidote for dipyridamole-induced AV block.
- Clinicians should be aware of this potential complication and its management.
Abstract:
Dipyridamole stress testing may be used in the diagnosis of coronary artery disease and risk assessment of patients who are unable to exercise. Although dipyridamole perfusion imaging has a good safety record, serious side-effects may rarely occur. We present a case in which dipyridamole induced high-grade atrioventricular (AV) block that responded promptly to intravenous aminophylline but not to atropine.