PROVOCATION OF CORONARY SPASM BY DOBUTAMINE STRESS ECHOCARDIOGRAPHY IN A PATIENT WITH ANGIOGRAPHICALLY MINIMAL CORONARY-ARTERY DISEASE

Dobutamine stress echocardiography (DSE) has been widely used for the noninvasive diagnosis of obstructive coronary artery disease. The ST-s egment elevation during DSE has been reported as an infrequent event, caused by old myocardial infarction and/or critical coronary narrowing s. The patient presented here was a 35-year-old man with a recent hist ory of nonexertional chest pain. He had hypercholesterolemia and a his tory of heavy smoking as risk factors. The patient developed ST-segmen t elevation with chest pain during 40 mcg/min dobutamine infusion for the stress echocardiographic examination. Subsequent coronary angiogra ms revealed only mild coronary atherosclerosis. It is speculated that coronary spasm occurred in this patient as a paradoxical response to i ncreased coronary blood flow with dobutamine administration.