Myocardial infarction during adenosine stress test

Polad, Jawed; Wilson, L M

doi:10.1136/heart.87.2.e2

Cited by 22 publications

(17 citation statements)

References 7 publications

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“…Previous studies have reported coronary vasospasm in single case as a side effect during adenosine stress [2][3][4] or after completion of adenosine stress [5][6][7]. We reported a series of 3 cases that showed typical signs and symptoms of coronary vasospasm after the completion of adenosine pharmacologic stress.…”

Section: Introductionmentioning

confidence: 77%

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Coronary spasm after completion of adenosine pharmacologic stress test

et al. 2011

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Adenosine is a frequently used pharmacologic stress agent in myocardial perfusion imaging. Its safety profile is well established, and most of its side effects are mild and transient. Coronary vasospasm occurs occasionally during or after adenosine stress test in rare cases, which may lead to seriously adverse outcomes. This study reported 3 such cases after completion of adenosine pharmacologic stress test.

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Section: Introductionmentioning

confidence: 77%

“…The previous studies have reported single case of coronary vasospasm during [2][3][4] and after adenosine stress [5][6][7]. In those previous studies, patients developed chest pain and ST elevation on ECG during or after adenosine infusion.…”

Section: Discussionmentioning

confidence: 93%

Coronary spasm after completion of adenosine pharmacologic stress test

et al. 2011

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“…In contrast to stress-induced ST segment depression, which tends to occur in the inferolateral electrocardiographic leads regardless of the site of coronary artery obstruction, exercise-induced ST segment elevation is usually localized to the area of ischemia (5,6). Vasodilator stress-induced ST segment elevation appears to be especially rare; review of the medical literature produced only two cases using dipyridamole (2, 7), three cases using adenosine (8)(9)(10), and one recently reported case using regadenoson (11). In all but one of these studies, coronary arteriography confi rmed >75% stenoses in at least one major coronary artery.…”

Section: Discussionmentioning

confidence: 99%

Coronary Angiographic Significance of Hyperacute St-T Changes Associated with Regadenoson Stress

Peters

Bhattasli²,

Burchett³

et al. 2013

Baylor University Medical Center Proceedings

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“…Therefore, adenosine has been used effectively in pharmacological myocardial stress tests [2]. Is it too safe?…”

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confidence: 99%

“…Is it too safe? In coronary artery disease, the predisposing factors to the development of regional ischemia (or even myocardial infarction) from adenosine infusion included transmural steal or diversion of blood from the subendocardium to the subepicardium in territory supplied by a stenosed vessel, reduction of distal perfusion pressure arising from increased flow across a stenosis and a generalized fall in perfusion pressure secondary to adenosine-induced vasodilatation with a reduction in flow through high-resistance collateral vessels supplying vulnerable territory [2]. Therapeutically, adenosine is commonly used to treat supraventricular tachycardia (SVT).…”

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confidence: 99%

Adenosine-Induced Tachyarrhythmia and Cardiac Arrest

El‐Menyar

Gehani

2010

Future Cardiol.

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Adenosine, an endogenous purine nucleoside, induces transient atrioventricular blockade (AVB) by suppressing sinus and atrioventricular node conduction. A lower intravenous dose (3-12 mg) is commonly used as an antiarrhythmic agent. Adenosine is also a known potent vasodilator of coronary and cerebral resistance vessels [1,101]. Adenosine acts on the A2 cell membrane receptor to increase the potent vasodilator cAMP; its action on this receptor is inhibited by both caffeine and theophylline. Adenosine is competitively antagonized by methylxanthines and potentiated by blockers of nucleoside transport such as dipyridamole. Adenosine-induced bradycardia is unlikely to be reversed by atropine. Adenosine has been effectively administered in the presence of quinidine, b-blockers, calcium-channel blocker agents and angiotensin converting enzyme inhibitors, without any change in the adverse reaction profile. Digoxin and verapamil use may be rarely associated with ventricular fibrillation when combined with adenosine. Carbamazepine has been reported to increase the degree of heart block produced by other agents [101].In healthy coronary arteries, the vasodilator response to the rise in cAMP during the standard protocol adenosine infusion results in a fourto five-fold increase in coronary blood flow. Therefore, adenosine has been used effectively in pharmacological myocardial stress tests [2]. Is it too safe? In coronary artery disease, the predisposing factors to the development of regional ischemia (or even myocardial infarction) from adenosine infusion included transmural steal or diversion of blood from the subendocardium to the subepicardium in territory supplied by a stenosed vessel, reduction of distal perfusion pressure arising from increased flow across a stenosis and a generalized fall in perfusion pressure secondary to adenosine-induced vasodilatation with a reduction in flow through high-resistance collateral vessels supplying vulnerable territory [2]. "Higher doses of adenosine causehigh-degree AVB, resulting in ventricular asystole and profound hypotension."Therapeutically, adenosine is commonly used to treat supraventricular tachycardia (SVT). After a bolus injection, the heart rate is dosedependently reduced until a complete AVB is reached. However, this effect on the atrioventricular node is transient and of short duration owing to the rapid inactivation of adenosine in human plasma by uptake into erythrocytes and endothelial cells. Is it too safe? Higher doses of adenosine cause high-degree AVB, resulting in ventricular asystole and profound hypotension. Therefore, doses greater than 12 mg are not recommended for adult or pediatric patients [101]. AVB is not uncommon when adenosine infusions are given during cardiac stress testing. In one study of 600 patients, adenosine infusion (140 µg/kg/min for 6 min) produced first-, second-and third-degree AVB in 13, 10 and 2% of patients, respectively [5,101]. The frequency of AVB depended upon the age group. The conduction block was of short duration and did not r...

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Myocardial infarction during adenosine stress test

Cited by 22 publications

References 7 publications

Coronary spasm after completion of adenosine pharmacologic stress test

Coronary spasm after completion of adenosine pharmacologic stress test

Coronary Angiographic Significance of Hyperacute St-T Changes Associated with Regadenoson Stress

Adenosine-Induced Tachyarrhythmia and Cardiac Arrest

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