Dynamic left ventricular outflow tract obstruction induced by dobutamine stress echocardiography leading to myocardial ischemia and infarction.
Left ventricular outflow tract (LVOT) obstruction occurring during dobutamine stress echocardiography (DSE) occurs in approximately 15-20% of patients undergoing DSE. The clinical significance and mechanism of LVOT obstruction has been debated, but is now generally felt to result from the pharmacological effects of dobutamine in increasing inotropy and causing peripheral vasodilation. It must be realized that in rare instances, ischemia may occur and lead to wall motion abnormalities and eventually myocardial infarction. We present the case of a 70-year-old asymptomatic woman who underwent a routine pre-operative cardiac stress evaluation and was found to develop a dynamic outflow tract obstruction leading to myocardial ischemia and infarction.
Makaryus
Amgad N
AN
Division of Cardiology, North Shore University Hospital, Manhasset, New York, USA.
Meraj
Perwaiz
P
Rosman
David
D
D000368:Aged; D001794:Blood Pressure; D002316:Cardiotonic Agents / Q000009:adverse effects*; D004280:Dobutamine / Q000009:adverse effects*; D025401:Echocardiography, Stress; D005260:Female; D006801:Humans; D009203:Myocardial Infarction / Q000139:chemically induced*; D014694:Ventricular Outflow Obstruction / Q000139:chemically induced*
D002316:Cardiotonic Agents; D004280:Dobutamine