DOBUTAMINE-INDUCED TRANSMURAL MYOCARDIAL-ISCHEMIA IN A PATIENT WITH MILD CORONARY LESIONS

A 70-year-old man was admitted for evaluation of retrosternal pain at rest. During infusion of dobutamine (25 mu g/kg/min) the patient devel oped angina, ST-segment elevation in the inferior leads, and echocardi ographic hypokinesia in the inferior-basal myocardial wall. Coronary a ngiography revealed insignificant (20-30%) stenosis of the right coron ary artery and a normal remaining tree. This case suggests that dobuta mine may induce transmural myocardial ischemia in patients with mild c oronary lesions, probably by producing occlusive coronary spasm on a s ubstrate of arterial endothelial dysfunction.