Syncope caused by severe hypotension and intraventricular gradient during dobutamine stress echocardiography [17] MARIA JOSÉ LOUREIRO, CARLOS COTRIM, OTÍLIA SIMÕES, RITA MIRANDA, SOFIA ALMEIDA, PEDRO CORDEIRO, PAULA FAZENDAS, ISABEL JOÃO, MANUEL CARRAGETA Serviço de Cardiologia, Hospital Garcia de Orta, Almada, Portugal Rev Port Cardiol 2008; 27 (2): 227-230 227 ABSTRACT Dobutamine stress echocardiography is widely used for the evaluation of coronary artery dis- ease. This form of stress echocardiography is safe but not without complications. We report a case of hypotension and syncope during dobut- amine stress echocardiography in which a severe intraventricular gradient of over 200 mmHg and systolic anterior movement of the mitral valve were observed. Palavras-Chave Dobutamine stress echocardiography; Complications; Syncope; Intraventricular gradient RESUMO Síncope causada por hipotensão grave e gradiente intraventricular durante eco- grafia de sobrecarga com dobutamina A ecocardiografia de sobrecarga com dobutamina é amplamente utilizada para a avaliação da doença das artérias coronárias. Esta forma de ecocardiografia de sobrecarga é segura, mas não isenta de complicações. Nós descrevemos um caso de hipotensão e síncope durante a ecocardiografia de stress com dobutamina, onde foi registado um gradiente intraventricular grave superior a 200 mmHg e movimento anterior sistólico da válvula mitral. Key words Ecocardiografia de stress com dobutamina; Complicações; Síncope; Gradiente intraventricular Recebido para publicação: Maio de 2007 • Aceite para publicação: Outubro de 2007 Received for publication: May 2007 • Accepted for publication: October 2007 INTRODUCTION T he use of dobutamine stress echocardiogra- phy for the evaluation of coronary artery dis- ease is rapidly expanding as a reliable, safe and cost-effective modality for the evaluation of patients with suspected myocardial ischemia or for prognostic stratification of these patients (1) . Despite the use of aggressive protocols, major side effects are a rare complication of this test (2) . Although rarely symptomatic, hypotension has been reported to occur in more than one third of patients during dobutamine stress echocardiogra- phy (3) . A case of syncope related to cardioinhibito- ry vagal reflex elicited by dobutamine stimulation of cardiac and aortic mechanoreceptors has been reported (4) . The authors report a case of hypoten- sion-associated syncope related to the develop- ment of a severe intraventricular gradient. CASE REPORT We report the case of a 56-year-old male with a history of smoking, hypercholesterolemia and high blood pressure who was referred for dobuta- mine stress echocardiography. This patient had a history of coronary artery disease and had previ- ously undergone coronary angiography that showed a 90% narrowing in the proximal left anterior descending artery, followed by successful percutaneous coronary intervention and stenting.