Ozcan Cevher, Zaret Barry L
Department of Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine 333 Cedar Street, 3FMP New Haven, Connecticut, 06520 USA.
Cases J. 2009 Jul 9;2:7466. doi: 10.4076/1757-1626-2-7466.
Chest pain with ST-segment elevation is a rare clinical problem during dobutamine stress testing. Although beta-agonists treatment prior to dobutamine stress testing has been shown to reduce the duration and amount of dobutamine infusion and atropine requirement, there is insufficient information about potential complications of this pharmacologic combination.
We present a 67-year-old patient with dobutamine stress testing -induced chest pain and ST elevation who received albuterol for clinical treatment of bronchospastic disease prior to the test. She developed persistent chest pain and ST elevation despite medical management. Urgent cardiac catheterization showed no significant obstructive coronary artery disease. Thus coronary artery spasm was likely responsible for the chest pain and electrocardiogram abnormality in our patient as a result of beta-agonist and dobutamine combination.
Beta-agonists pre-treatment with dobutamine stress testing may induce coronary spasm in association with chest pain and ST elevation. Clinicians and nuclear cardiologist should be aware of this potential side effect of beta-agonists treatment with dobutamine stress testing, particularly since dobutamine stress testing in nuclear cardiology is done in patient with chronic obstructive lung disease.
在多巴酚丁胺负荷试验期间，伴有ST段抬高的胸痛是一个罕见的临床问题。尽管多巴酚丁胺负荷试验前使用β受体激动剂治疗已被证明可减少多巴酚丁胺输注的持续时间和剂量以及阿托品的需求量，但关于这种药物组合潜在并发症的信息不足。
我们报告一名67岁患者，在多巴酚丁胺负荷试验时出现胸痛和ST段抬高，该患者在试验前因支气管痉挛性疾病接受沙丁胺醇临床治疗。尽管进行了药物治疗，她仍持续胸痛和ST段抬高。紧急心脏导管检查显示无明显阻塞性冠状动脉疾病。因此，由于β受体激动剂与多巴酚丁胺联合使用，冠状动脉痉挛可能是我们患者胸痛和心电图异常的原因。
多巴酚丁胺负荷试验前使用β受体激动剂预处理可能会诱发冠状动脉痉挛并伴有胸痛和ST段抬高。临床医生和核心脏病专家应意识到β受体激动剂与多巴酚丁胺负荷试验联合治疗的这种潜在副作用，特别是因为核心脏病学中的多巴酚丁胺负荷试验是在慢性阻塞性肺疾病患者中进行的。
