Chest pain dobutamine

In 47 consecutive patients (mean age 64 years, 46 men) with three or more cardiovascular risk factors, intravenous dobutamine was given at a rate of 40micro-grams/kg/minute until the target heart rate was achieved, which took a mean of 11.6 minutes (4). Subjective sensations occurred in 49% of the patients (palpitation 21%, chest pain 6%, nausea 6%, headache 6%, dizziness 13%), while half the patients had abnormal cardiac rhythms (ventricular extra beats 38%, supraventricular tachycardia 10%, and non-sustained ventricular tachycardia 2%). The authors concluded that the safety and tolerability of this procedure is comparable to that of standard dobutamine stress testing, although its specificity and selectivity are still uncertain. 

A report from the Mayo Clinic has described 27 elderly patients (mean age 71 years) with aortic stenosis in whom dobutamine stress hemodynamic testing was used to assess the severity of the stenosis (12). There were no severe adverse effects, but relatively minor problems occurred in 16 patients, including chest pain and ventricular extra beats (n = 9 each) and atrial dysrhythmias (n — 4). The authors concluded that the procedure appears to be safe in these high-risk patients, although its diagnostic value may be limited. 

Myocardial ischemia has also been reported in susceptible patients. A Japanese group carried out dobutamine stress echocardiography in 51 patients with a presumptive diagnosis of variant angina (17). All had coronary vasospasm in response to intracoronary acetylcholine and seven also had chest pain and reversible ST segment elevation. One must incidentally wonder whether this procedure was entirely advisable. 

Adverse reactions to ultrasound contrast agents (SonoVue 46% and Luminity 54%) have been assessed in 3704 patients, of whom 1150 underwent stress echocardic -raphy with exercise or dobutamine [SS ]. There was no excess of adverse events in those with stable chest pain or suspected acute coronary syndrome. 

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