Dobutamine‐induced transmural myocardial ischemia in a patient with mild coronary lesions

A 70‐year‐old man was admitted for evaluation of retrosternal pain at rest. During infusion of dobutamine (25 μg/kg/min) the patient developed angina, ST‐segment elevation in the inferior leads, and echocardiographic hypokinesia in the inferior‐basal myocardial wall. Coronary angiography revealed insignificant (20‐30%) stenosis of the right coronary artery and a normal remaining tree. This case suggests that dobutamine may induce transmural myocardial ischemia in patients with mild coronary lesions, probably by producing occlusive coronary spasm on a substrate of arterial endothelial dysfunction.