Clinical significance of abrupt vasodepression during dobutamine stress echocardiography

Mazeika, P; Nadazdin, A; Oakley, Celia M.

doi:10.1016/0002-9149(92)90907-g

Cited by 52 publications

(9 citation statements)

References 13 publications

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“…Although hypotensive response during exercise has strongly been associated to myocardial ischemia and poor cardiac prognostic, hypotension during dobutamine infusion cannot be consider as a specific indicator of cardiac anomalies [16]. The mechanism of hypotensive response during dobutamine infusion remains unclear, vigorous myocardial contraction around a small chamber may trigger sympathoinhibition and increased parasympathetic discharge, leading to a systemic hypotension [17].…”

Section: Discussionmentioning

confidence: 99%

Stress echocardiography: safety and tolerability

Fennich

Ellouali

Abdelali

et al. 2013

Cardiovasc Ultrasound

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BackgroundStress echocardiography is a valuable tool for the noninvasive diagnosis of ischemic heart disease. Despite its widely use in the clinical practice, safety and side effects profile have never been evaluated in Moroccans.The aimTo assess the safety and tolerability of the two stress echo modalities in Moroccans.MethodsThe study was made by 311 patients with known or suspected coronary artery disease, 203 underwent exercise echocardiography and 108 underwent dobutamine echocardiography, major and minor rhythmic complications and side effects were recorded for the two groups.ResultsWe registered 3 (2, 8%) major rhythmic events in the dobutamine group (2 sustained supraventricular tachycardia and 1 sustained ventricular tachycardia), there was no major rhythmic events in the exercise group. Minor rhythmic events were frequent (43, 5% in the dobutamine group and 19, 2% in the exercise group with a p = 0, 0001). Severe hypotension occurs in 4 (3, 7%) patients during a dobutamine stress, there was no significant drop in the blood pressure during exercise stress procedures. Non cardiac side effects were more common among patients who underwent a dobutamine stress echo (13, 9% vs. 3, 4% with p = 0,001).ConclusionExercise is safer than dobutamine stress echocardiography, complications and adverse effects with the use of dobutamine are usually minor and self-limiting.

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Section: Discussionmentioning

confidence: 99%

Stress echocardiography: safety and tolerability

Fennich

Ellouali

Abdelali

et al. 2013

Cardiovasc Ultrasound

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“…A syndrome characterized by dizziness, bradycardia and hypotension has occasionally been described during DSE [2,3,5]. This syndrome is thought to be due to vagal activation caused by stimulation of mechanical receptors in the aorta or myocardium resulting in sympathetic withdrawal and enhanced parasympathetic activity [6,7].…”

Section: Discussionmentioning

confidence: 99%

Sinus Node Dysfunction Unmasked during Dobutamine Stress Echocardiography

Khan

Bustros²,

Mitre³

et al. 2011

Cardiology

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Sinus bradycardia and associated isorhythmic AV dissociation may be seen during dobutamine stress echocardiography. This phenomenon is usually considered a benign peri-procedural event and is thought to be secondary to the Bezold-Jarisch reflex, with profound heart rate decrease secondary to a marked increased in vagal efferent discharge. To the best of our knowledge, dobutamine stress echocardiography unmasking clinically relevant sinus node dysfunction has never been reported. We report a case of a 50-year-old man presenting with chest pain and a history of syncope, who had worsening sinus bradycardia with isorhythmic AV dissociation during dobutamine stress echocardiography. An invasive electrophysiological study revealed marked sinus node dysfunction. The patient was referred for the insertion of a permanent pacemaker for sinus node dysfunction, chronotropic incompetence and symptomatic bradycardia. Dobutamine-associated bradycardia may not always be a benign peri-procedural physiologic effect, as in this case it may unmask clinically significant sinus node dysfunction.

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“…1998). The exact mechanism responsible for the hypotension is unclear, but has been attributed to vasodepressor reflexes (Mazeika et al. 1992; Emre et al.…”

Section: Discussionmentioning

confidence: 99%

“…However, in people without evidence of coronary artery disease undergoing stress echocardiography with dobutamine, approximately 20% develop paradoxical hypotension and 10% develop bradycardia (Rallidis et al 1998). The exact mechanism responsible for the hypotension is unclear, but has been attributed to vasodepressor reflexes (Mazeika et al 1992;Emre et al 1999), induction of left ventricular outflow tract obstruction (Pellikka et al 1992), and inadequate increase in cardiac output because of impaired systolic reserve (Tanimoto et al 1995). With the latter two mechanisms, there was typically an increase in heart rate with a concurrent decrease in systolic arterial pressure.…”

Section: Discussionmentioning

confidence: 99%