Acute complications in dobutamine-atropine stress echocardiography.

The presented case report describes lifethreatening complications of pharmacological stress echocardiography with dobutamine. A 66-year old male suffered an acute anterior wall myocardial infarction during dobutamine-atropine stress echocardiography. Symptoms and signs of myocardial infarction developed after maximal dobutamine-dose (40 mu g/kg/min) and the additional application of atropine. Emergency coronary angiography revealed extensive coronary artery disease with proximal occlusion of the left anterior descending artery which was successfully recanalized. In a second patient ventricular fibrillation echocardiography and electrocardiographic signs of acute myocardial ischemia developed after high-dose dobutamine stress and required prolonged resuscitation. The possible mechanisms, incidence and risk of acute myocardial ischemia during dobutamine-atropine stress are discussed and compared to bicycle ergometry. The presented life-threatening complications of dobutamine-atropine stressechocardiography emphasize the importance of available and adequate emergency facilities.