Dobutamine
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Stroke during stress echocardiography: case report A 35-year-old dialysis-dependent woman with end-stage renal disease experienced a stroke during a dobutamine stress echocardiography. The woman, who had a mechanical mitral valve prosthesis, underwent the dobutamine stress echocardiography [details of drug administration not stated] as part of a preoperative cardiac risk assessment before renal transplantation. Five minutes after stress testing, dysphasia occurred, with right upper extremity numbness and weakness. Despite taking warfarin, her INR was found to be subtherapeutic (1.0). The woman’s symptoms partially resolved, and she was admitted for anticoagulation. A 4 × 2mm thrombus attached to the mitral prosthesis was evident on transoesophageal echocardiography. MRI of the brain revealed a small focal infarct in the left precentral gyrus, white matter changes, and scattered diffuse microhaemorrhages. Within 18 hours, her symptoms had totally resolved, and she was discharged home with full anticoagulation and no further problems. Author comment: "It is speculated that the most likely mechanism of stroke in this patient was thrombus dislodgement from the mitral prosthesis, produced by mechanical factors associated with dobutamine stress testing." Aftab W, et al. Dobutamine stress-induced stroke in a patient with mechanical mitral prosthesis despite normal function. Journal of Heart Valve Disease 21: 803079347 407-9, No. 3, May 2012 - USA
0114-9954/10/1427-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 10 Nov 2012 No. 1427
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