ROLE OF DOBUTAMINE STRESS ECHOCARDIOGRAPHY IN GUIDING THERAPEUTIC DECISION-MAKING IN CORONARY ARTERY DISEASE
Abstract:
Dobutamine stress echocardiography (DSE) is an established non-invasive diagnostic
method used to assess the severity of coronary stenosis or to identify viable myocardium in patient
with known or suspected coronary artery disease. During DSE wall motion abnormalities are
frequently associated with ST segment depression in 12-lead electrocardiogram (ECG), while ST
segment elevation during DSE is an uncommon finding. We report a case of a patient who developed
wall motion abnormalities associated with ST segment elevation at DES and presented severe
coronary spasm without significant coronary artery stenosis on angiography. The patient had no
history of myocardial infarction or critical coronary artery stenosis to justify the ECG and
echocardiographic abnormalities. These changes could be explained by a phenomenon of severe
coronary spasm, an uncommon cause of false positive results of DSE. Hypercholesterolemia and
smoking may have predisposed this abnormal coronary vasoconstricting response.
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