Heart and Vascular Institute, Penn State Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
Medicine, Penn State Milton S Hershey Medical Center, Hershey, Pennsylvania, USA.
BMJ Case Rep. 2020 Aug 31;13(8):e235206. doi: 10.1136/bcr-2020-235206.
A 53-year-old woman with atypical chest pain underwent a dobutamine stress echocardiogram (DSE) and developed a coronary spasm (CS) with severe pain and dramatic ST-segment elevation 9 min after dobutamine infusion was discontinued. The spasm resolved after sublingual nitroglycerin administration. The same-day coronary angiogram showed non-significant stenosis in the three coronary territories. Retrospectively, we found that the patient had vasospastic angina (VSA), a condition that has been strongly associated with the development of dobutamine-induced CS. Mechanisms of dobutamine-induced CS are not fully understood and include endothelial dysfunction leading to deficient nitric oxide-mediated coronary vasodilation in response to increased myocardial oxygen demand as well as imbalance between β1 and β2 adrenergic effects of dobutamine. Dobutamine-induced CS has also been much more frequently reported in patients from Asian descent with VSA. VSA should be systemically recognised in patients considered for DSE and, if present, other modalities of stress imaging should be discussed.
一位 53 岁女性因非典型胸痛接受了多巴酚丁胺负荷超声心动图（DSE）检查，在多巴酚丁胺输注停止后 9 分钟出现冠状动脉痉挛（CS），伴有剧烈疼痛和明显的 ST 段抬高。舌下含服硝酸甘油后痉挛缓解。同日行冠状动脉造影显示三个冠状动脉区域无明显狭窄。回顾性检查发现患者患有血管痉挛性心绞痛（VSA），这与多巴酚丁胺诱导的 CS 发展密切相关。多巴酚丁胺诱导 CS 的机制尚未完全阐明，包括内皮功能障碍导致在心肌需氧量增加时缺乏一氧化氮介导的冠状动脉扩张，以及多巴酚丁胺的β1 和β2 肾上腺素能作用之间的失衡。多巴酚丁胺诱导 CS 在亚洲裔 VSA 患者中更为常见。在考虑进行 DSE 的患者中应系统识别 VSA，如果存在，应讨论其他应激成像方式。
