The University of Manchester, United Kingdom
Dr M Asad is a junior doctor at The Royal Oldham Hospital, Manchester, United Kingdom. She is an MbCHB with French Medical Studies Diploma and Masters in Public Health and Global Health.
Dobutamine stress echo (DSE) is a consistently employed non-invasive exercise-independent stress modality used to localize and assess coronary artery disease and myocardial ischaemia. DSE is a highly sensitive method for detection and localization of coronary artery disease. It is an internationally used test for the evaluation of patients with known or suspected coronary artery disease. The safety profile of the test has been widely examined via large studies involving sizeable cohorts of patients.Coronary vasospasm leading to ST elevation is a rare but documented complication of the test. Dobutamine, as a pharmacologic agent, although noted to cause vasoconstriction, has not been associated with coronary spasm. However, there are rare reports describing ECG ST segment elevation during dobutamine infusion in the absence of significant coronary artery disease or previous myocardial infarction, suggesting that dobutamine induced coronary artery spasm may occur.Myocardial ischaemia induced by dobutamine is frequently associated with ST segment depression on ECG. However, ST elevations during DSE have been documented in several isolated reports and are an important source of false positive results.This is an important case series detailing three cases where coronary artery spasm during DSE resulted in electrocardiogram changes and subsequent angioplasty. Localisation of coronary artery occlusion was varied between ECGs during DSE and angioplasty, and in one case normal coronary arteries were observed. This could be due to dobutamine induced coronary artery spasm phenomenon. This case series has some important practical implications for interventional cardiologists.