Myocardial infarction as a complication of dobutamine stress echocardiography,☆☆,

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Abstract

Only few cases of myocardial infarction complicating dobutamine stress echocardiography have been reported. We observed a 42-year-old woman in whom acute inferior wall infarction developed 10 minutes after discontinuation of dobutamine stress echocardiography with up to 20 μg/kg/min dobutamine. The right coronary artery, which had had a 50% stenosis in the prior angiography, showed proximal complete occlusion on the immediately performed recatheterization. Thrombolysis in myocardial infarction study flow grade 3 was rapidly accomplished by intracoronary thrombolysis with recombinant tissue type plasminogen activator. For recurrent unstable angina, the patient received coronary bypass grafting on the same day. The case shows that myocardial infarction not preceded by regional wall motion abnormalities is a possible complication of dobutamine stress echocardiography. Post-test monitoring even after negative tests is recommended. (J Am Soc Echocardiogr 1997;10:768-71.)

Section snippets

Case Report

A 42-year-old woman had an anteroseptal MI and received thrombolytic therapy with streptokinase 6 hours after the onset of symptoms. Maximum creatine phosphokinase level was 930 U/L. Repeated echocardiography showed akinesia of the apical anterior wall and dyskinesia with the development of aneurysm of the apex and apical septum. Global left ventricular function was moderately depressed. Except for a single episode of postinfarction angina, the patient was stable for the subsequent 3 weeks. She

Discussion

Since the introduction of the dipyridamole test in 1976,5 pharmacologic stress tests have been useful tools for the diagnosis and risk stratification in coronary heart disease. Stress echocardiography with dipyridamole or adrenergic agents is widely applied in hospitalized as well as in ambulatory patients with known or suspected CAD. Indications range from prognostic stratification after MI or before major surgery through screening for significant CAD in patients with inconclusive exercise

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From the Department of Medicine, Division of Cardiology, Leverkusen Teaching Hospital.

☆☆

Reprint requests: Bernd Weidmann, MD, Department of Medicine, Division of Cardiology, Leverkusen Teaching Hospital, Dhuennberg 60, 51375 Leverkusen, Germany.

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