Dobutamine-induced transmural myocardial ischemia in a patient with mild coronary lesions.
A 70-year-old man was admitted for evaluation of retrosternal pain at rest. During infusion of dobutamine (25 micrograms/kg/min) the patient developed angina, ST-segment elevation in the inferior leads, and echocardiographic hypokinesia in the inferior-basal myocardial wall. Coronary angiography revealed insignificant (20-30%) stenosis of the right coronary artery and a normal remaining tree. This case suggests that dobutamine may induce transmural myocardial ischemia in patients with mild coronary lesions, probably by producing occlusive coronary spasm on a substrate of arterial endothelial dysfunction.
Kardaras
F G
FG
First Department of Cardiology, Evangelismos Hospital, Athens, Greece.
Bonou
M S
MS
Kardara
D F
DF
Kranidis
A I
AI
Sioras
E P
EP
Anthopoulos
L P
LP
D000318:Adrenergic beta-Agonists / Q000009:adverse effects*; D000368:Aged; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging; D004280:Dobutamine / Q000009:adverse effects*; D004452:Echocardiography; D004562:Electrocardiography; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000139:chemically induced* / Q000175:diagnosis
D000318:Adrenergic beta-Agonists; D004280:Dobutamine