ABSTRACT
A 53-year-old woman with atypical chest pain underwent a dobutamine stress echocardiogram (DSE) and developed a coronary spasm (CS) with severe pain and dramatic ST-segment elevation 9 min after dobutamine infusion was discontinued. The spasm resolved after sublingual nitroglycerin administration. The same-day coronary angiogram showed non-significant stenosis in the three coronary territories. Retrospectively, we found that the patient had vasospastic angina (VSA), a condition that has been strongly associated with the development of dobutamine-induced CS. Mechanisms of dobutamine-induced CS are not fully understood and include endothelial dysfunction leading to deficient nitric oxide-mediated coronary vasodilation in response to increased myocardial oxygen demand as well as imbalance between ß1 and ß2 adrenergic effects of dobutamine. Dobutamine-induced CS has also been much more frequently reported in patients from Asian descent with VSA. VSA should be systemically recognised in patients considered for DSE and, if present, other modalities of stress imaging should be discussed.
Subject(s)
Coronary Vasospasm/chemically induced , Coronary Vasospasm/drug therapy , Dobutamine/adverse effects , Echocardiography, Stress , Contraindications, Drug , Coronary Angiography , Female , Humans , Middle Aged , Treatment OutcomeABSTRACT
The abundance of, and reliance upon, human electro-muscular incapacitation (HEMI) devices, especially in law enforcement, has generated scrutiny and examination of these technologies. The purpose of this study was to examine cardiovascular effects resulting from typical (5 sec) and longer activation (20 sec) HEMI applications studying myocardial function and peripheral vascular system using a combination of invasive cardiovascular catheters and transesophageal echocardiography (TEE). Six healthy swine (Sus scrofa) 3-5 months in age and weighing between 60 and 86 kg were anesthetized and exposed to the TASER Model X26 waveform while transesophageal echocardiography was performed. Stroke volume was shown to statistically decrease during HEMI application indicating an increase in systemic vascular resistance, but HEMI application did not result in myocardial dysfunction ("cardiac stunning").
Subject(s)
Echocardiography, Transesophageal , Electric Stimulation/instrumentation , Stroke Volume , Vascular Resistance , Weapons , Animals , Blood Pressure , Blood Volume , Carbon Dioxide/blood , Cardiac Catheterization , Catheters, Indwelling , Central Venous Pressure , Forensic Medicine , Hematocrit , Hemoglobins/analysis , Humans , Hydrogen-Ion Concentration , Lactic Acid/blood , Models, Animal , Muscle Contraction , Potassium/blood , Sodium/blood , SwineABSTRACT
Use of the Avalon Elite bicaval dual lumen catheter (Maquet Cardiopulmonary AG, Rastatt, Germany) can be effective in patients requiring venovenous extracorporeal membrane oxygenation (VV-ECMO) for adult respiratory distress syndrome (ARDS). Proper placement of the cannula is important in providing adequate therapy and avoiding life-threatening complications. We report a case of successful cannulation in a patient with an implanted atrial septal defect (ASD) occlusion device who developed severe refractory ARDS.
