RESUMO
PURPOSE: To detect myocardial ischemia during dobutamine stress echocardiography (DSE). METHODS: Two hundred and seventy one patients were studied; 63 (23%) underwent coronary angiography within a month of DSE. Angiograms were analyzed independently by 3 angiographers, and coronary lesions larger than 50% of luminal occlusion were considered likely to cause ischemia. RESULTS: The global sensitivity and specificity were 95% and 75% respectively, with 89% accuracy. Of 43 patients showing obstructive coronary artery disease, there were 2 false negatives. One of 5 false positives had ischemic cardiomyopathy and another a technically difficult exam. The symptoms and side effects in decreasing order of occurrence are as follows: palpitation 46%; arrhythmia 24%; mild hypotension 24%; chest pain 8%; hypertension 5%; facial paresthesia 4%; chills 1.8%; nausea 1.8%; headache 1.4%; dyspnea 0.4% and severe hypotension 0.4%. CONCLUSION: Considering the results, the small number of complications and the feasibility, DSE seems to be a safe and promising method for detecting myocardial ischemia.
Assuntos
Dobutamina , Ecocardiografia/métodos , Isquemia Miocárdica/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia Coronária , Dobutamina/administração & dosagem , Teste de Esforço/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e EspecificidadeRESUMO
A 49 year-old woman with acute pulmonary thromboembolism and severe hemodynamic impairment was successfully treated with tissue-type plasminogen activator (r-TPA). She did not have previous pulmonary or cardiac diseases. Thirty days after immobilization of the right ankle, she had a sudden onset of dyspnea, epigastrial pain and syncope. As heparin therapy was unsuccessful, 90 mg of IV r-TPA was administered. There was rapid clinical and hemodynamic improvement of her condition. Pulmonary scanning one week later was normal and she was discharged without symptoms 12 days after the acute episode.