Case Report

Dobutamine-Induced Complete Heart Block

Authors: Lekshmi Vaidyanathan, MBBS, Nishant Anand, BA, Latha G. Stead, MD, Eric T. Boie, MD, Matthew D. Sztajnkrycer, MD, Deepi G. Goyal, MD

Abstract

Dobutamine is commonly administered as a pharmacologic stressor in patients with limitations precluding exercise testing. The case report presented is one of transient complete heart block resulting from dobutamine sestamibi stress testing. Shortly after initiating the dobutamine infusion, the patient became pale and presyncopal, with hypotension and a heart rate of 50 beats per minute. Subsequently, third-degree heart block developed which lasted transiently and resolved. Subsequent cardiac evaluation of the patient revealed no cardiac etiology for her symptoms. Though bradycardia is infrequently noted in patients receiving dobutamine during stress electrocardiogram, complete heart block is a possibility during dobutamine-induced stress echocardiography and must be recognized as a potential risk.


Key Points


* Bradycardia is infrequently noted in patients receiving dobutamine during stress electrocardiogram (ECG).


* Transient conduction block, atrioventricular block (Mobitz type I and type II) has been reported in dobutamine stress ECG.


* Complete heart block is a possible complication of dobutamine sestamibi stress testing.

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References

1. Orsinelli DA, Daniels CJ. Pharmacologic stress echocardiography. Dobutamine and arbutamine stress testing. Cardiol Clin 1999;17:461–479, viii.
 
2. Fung AY, Gallagher KP, Buda AJ. The physiologic basis of dobutamine as compared with dipyridamole stress interventions in the assessment of critical coronary stenosis. Circulation 1987;76:943–951.
 
3. Product Information. Dobutrex® Solution (dobutamine hydrochloride), Eli Lilly and Company. Physicians’ Desk Reference. Montvale, NJ, Medical Economics Data Production Company, 1995, ed 49, pp 1325–1326.
 
4. Marcus R. Agents affecting calcification and bone turnover: calcium, phosphate, parathyroid hormone, vitamin D, calcitonin, and other compounds, in Hardman JG, Limbird LE, Gilman AG (eds): Goodman & Gilman’s The Pharmacological Basis of Therapeutics. New York, McGraw-Hill Medical Publishing Division, 2001, ed 10, p 1737.
 
5. Leier CV, Unverferth DV. Drugs five years later. Dobutamine. Ann Intern Med 1983;99:490–496.
 
6. Poldermans D, Fioretti PM, Forster T, et al. Dobutamine stress echocardiography for assessment of perioperative cardiac risk in patients undergoing major vascular surgery. Circulation 1993;87:1506–1512.
 
7. Blomstrand P, Engvall J, Swahn E, et al. Cardiovascular effects of dobutamine stress testing in women with suspected coronary artery disease. Heart 1996;75:463–468.
 
8. Hirano Y, Yamamoto T, Uehara H, et al. Complications of stress echocardiography [Japanese]. J Cardiol 2001;38:73–80.
 
9. Scandura S, Felis S, Barbagallo G, et al. Significance of hypotension and vasovagal reflex during echo-stress using high doses of dobutamine [Italian]. Cardiologia 1997;42:287–292.
 
10. Emre A, Ersek B, Gursurer M, et al. Myocardial perfusion and angiographic findings in patients with paradoxical sinus deceleration during dobutamine technetium-99m sestamibi-gated SPECT imaging. Cardiology 1999;92:183–188.
 
11. Dawes GS, Comroe JH Jr. Chemoreflexes from the heart and lungs. Physiol Rev 1954;34:167–201.
 
12. Hung KC, Lin FC, Chern MS, et al. Mechanisms and clinical significance of transient atrioventricular block during dobutamine stress echocardiography. J Am Coll Cardiol 1999;34:998–1004.