Beta Adrenergic Receptor Blockade Causing Severe Left Ventricular Systolic Dysfunction during Dobutamine Stress Echocardiography in a Patient with No Structural Heart Disease

Abstract

A 41-year-old woman with a history of neurocardiogenic syncope treated with beta-blockers was admitted with chest pain. Dobutamine echocardiogram images demonstrated decreased global LV systolic wall motion and thickening. Coronary angiograms were normal. Beta-blockers were stopped and dobutamine stress echocardiogram (DSE) was repeated. Dobutamine images demonstrated increased global LV systolic wall motion and thickening. Beta-blockers were restarted and again dobutamine produced global LV dysfunction. This case suggests that DSE wall motion response may be falsely abnormal in a patient on beta-blockers. Physicians should be aware of this possibility when interpreting dobutamine echocardiography in patients taking beta-blockers.

The Value of β‐Blockers Administration during Recovery Phase of Dobutamine Stress Echocardiography: A Review

“…28 Interestingly, the use of chronic b-blocker therapy before DASE has not been associated with lower sensitivity for ischemia detection. It states that pretreatment with b-blockers during DSE was associated with global hypokinesia induced by dobutamine, despite normal coronaries.…”

“…Only when the b-blocker was reinitiated, could the global hypokinesia be reproduced. 28 Interestingly, the use of chronic b-blocker therapy before DASE has not been associated with lower sensitivity for ischemia detection. 29…”