Large Intracranial Hemorrhage after Dobutamine Stress Echocardiography

We report the case of a fatal intracranial hemorrhage after dobutamine stress echocardiography for chest pain in a 63-year-old female with no previous vascular risk factors. The patient experienced severe headache during stress testing and became clinically unresponsive 2-3 hours afterward. Imaging demonstrated a large 7.9 cm × 6.7 cm intracerebral hemorrhage (ICH) with subfalcine herniation. This is the first reported of a fatal ICH after dobutamine infusion. In large reviews of dobutamine use for cardiac stress testing, the agent has been proven to have a generally safe risk profile. However dobutamine may rarely produce life-threatening events in susceptible patients. Physicians should be aware of cerebrovascular complications, due to agent’s hypertensive effects, as another rare, but possible complication of dobutamine infusion.