Paradoxical sinus deceleration during dobutamine stress echocardiography: case series and review of the literature

Abstract

Background Dobutamine stress echocardiography is an established diagnostic modality for assessing myocardial ischemia in patients with known or suspected coronary artery disease. Dobutamine infusion causes dose dependent increase in heart rate and contractility. However, in some cases it induces paradoxical sinus deceleration, whose underlying mechanism and clinical significance is not fully understood. Case Summary We present episodes of paradoxical sinus deceleration observed during dobutamine stress echocardiography in six (four males and two females) patients and described its patterns of occurrence and clinical and echocardiographic characteristics. Discussion Paradoxical sinus deceleration occurred mostly at maximal dobutamine infusion, was accompanied with a decline in blood pressure and resolved spontaneously following cessation of dobutamine infusion. Individuals experiencing paradoxical sinus deceleration had in common abnormal left ventricle geometry but differed with regard to age, sex and cardiometabolic risk factors.

The Possibility of Hypersensitivity Myocarditis following COVID-19 Vaccines: Implications for Contrast Echocardiography

“…In that role, we encounter PEGs in the mRNA-based COVID-19 vaccines, both in mRNA-1273 by Moderna and in BNT162b2 by Pfizer-BioNTech [4]. Another important group of substances that contain PEGs is ultrasound contrast agents (UCAs) which are used during echocardiography for better endomyocardial border detection to assess regional wall motion abnormalities, left ventricular thrombus, car-diomyopathies, and myocardial perfusion [5]. The safety profile of UCAs is generally good, with less than 1 serious adverse event in 10,000 examinations [6].…”

Risk factors and major adverse cardiovascular events of isolated coronary artery ectasia: An observational study

“…[ 7 ] Dobutamine stress echocardiography (DSE) induces myocardial ischemia (MI) in the stenotic coronary artery supply area by increasing myocardial oxygen consumption, and can detect MI that is difficult to detect by conventional echocardiography in a resting state, which is also important first-line noninvasive imaging technique for risk stratification and guiding revascularization in patients with MI. [ 8 ] However, there is a lack of prognostic evaluation methods, and risk factors for isolated CAE remain controversial. In this study, we aimed to use MCE combined with DSE to evaluate the cardiac index and follow-up on whether there are major adverse cardiovascular events (MACE) events within 1 year between the isolated CAE and control groups, and this study also aims to provide a basis for risk stratification of CAE patients.…”

Paroxysmal sinus deceleration: an under-recognized show stopper

“…In fact, Sulo and colleagues report coronary artery disease in just 1 of 6 (17%) patients with paroxysmal sinus deceleration, while Attenhofer and colleagues report this phenomenon in 8 of 14 (57%) of their patients. 4 , 6 The broad definition of coronary artery disease used by Attenhofer and colleagues may account for these differences, whereby inclusion of coronary arterial stenoses of ≥50% may have encompassed some patients with non-haemodynamically significant coronary arterial stenosis. 4 Regardless, there has been no demonstrated increase in the incidence of right coronary arterial disease as a mechanism for this phenomenon.…”

“… 9 , 10 Given that paroxysmal sinus deceleration typically develop at a dobutamine dose of at least 20 μg/kg/min, early administration of atropine commencing at 20 μg/kg/min may attenuate this effect. 4 , 6 , 11 …”