Intracranial Hemorrhage as a Complication of Dobutamine Stress Echocardiography: Case Report and Review of the Literature

• Published in: Echocardiography (Mount Kisco, N.Y.) N.Y.), 2012-05, Vol.29 (5), p.E119-E121
• Main Authors: Shah, Sachin P., Muqtada Chaudhry, G.
• Format: Article
• Language: English
• Subjects: Aged; Aneurysm; Brain; Case reports; Complications; Dobutamine - adverse effects; dobutamine stress echocardiography; Echocardiography; Echoencephalography - adverse effects; Echoencephalography - methods; Exercise Test - adverse effects; Heart diseases; Hemorrhage; Humans; Hypertension; intracranial hemorrhage; Intracranial Hemorrhage, Hypertensive - diagnostic imaging; Intracranial Hemorrhage, Hypertensive - etiology; Intracranial Hemorrhage, Hypertensive - prevention & control; intraparenchymal hemorrhage; Literature reviews; Male; Mitral valve; Piperazines - adverse effects; Prosthetics; Side effects; Stress; Tumors; Warfarin
• ISSN: 0742-2822; 1540-8175
• DOI: 10.1111/j.1540-8175.2011.01623.x

Dobutamine stress echocardiography is a generally well‐tolerated study to evaluate patients with suspected coronary artery disease. Rare but life‐threatening complications of this study have been well described. Severe hypertensive responses are a known but uncommon adverse reaction to dobutamine infusion. The authors report a case of intracranial hemorrhage in the setting of severe hypertension as a complication of dobutamine stress echocardiography. The patient was on systemic anticoagulation with warfarin for a prosthetic mitral valve and had an international normalized ratio (INR) of 3.8 that was slightly over the therapeutic goal INR of 2.5–3.5. He had no predisposing intracranial lesions such as tumor, vascular malformation, or aneurysm. He suffered an intraparenchymal hemorrhage in three distinct areas of his brain. Intracranial hemorrhage related to dobutamine infusion has not been reported previously, but given the known risk of hypertension, life‐threatening sequelae including intracranial hemorrhage are possible. (Echocardiography 2012;29:E119‐E121) Dobutamine stress echocardiography is a generally well‐tolerated study to evaluate patients with suspected coronary artery disease. Rare but life‐threatening complications of this study have been well described. Severe hypertensive responses are a known but uncommon adverse reaction to dobutamine infusion. The authors report a case of intracranial hemorrhage in the setting of severe hypertension as a complication of dobutamine stress echocardiography.