Generalized myoclonus following dobutamine stress echocardiography: a case report.
- 1Department of Anesthesiology, Asklepieion General Hospital of Voula, Vas. Pavlou Ave. 1, Athens 16673, Greece.
- 2Department of Cardiology, Asklepieion General Hospital of Voula, Vas. Pavlou Ave. 1, Athens 16673, Greece.
Abstract
Dobutamine stress echocardiography (DSE) is a widely used and generally safe non-invasive imaging modality for the assessment of myocardial ischaemia. Adverse effects are predominantly cardiovascular, whereas neurological complications are exceedingly rare. Dobutamine-induced myoclonus (DIM) has only rarely been reported, mainly in patients receiving prolonged dobutamine infusions for heart failure or cardiomyopathy. A 47-year-old woman underwent DSE for evaluation of exertional chest pain. Following completion of a standard dobutamine protocol, she developed generalized rhythmic myoclonic jerks predominantly involving the axial musculature. The patient remained fully conscious and hemodynamically stable throughout the episode. Intravenous diazepam failed to improve symptoms, whereas complete resolution occurred after administration of intravenous valproic acid. Laboratory investigations, including electrolytes, renal function, and thyroid function tests, were normal. Electroencephalography and brain magnetic resonance imaging revealed no abnormalities. No recurrence was observed during hospitalization or follow-up. To our knowledge, this is the first reported case of DIM occurring immediately after DSE. Unlike previously published cases, which predominantly involved patients with chronic kidney disease and developed after prolonged dobutamine exposure, our patient had normal renal function and developed symptoms immediately upon completion of the stress protocol. The pathophysiology remains uncertain, although increased central nervous system exposure to dobutamine has been proposed. Clinicians performing DSE should be aware of myoclonus as a rare but important neurological complication and should consider valproic acid when benzodiazepines fail to achieve symptom control.
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BibTeX
@article{bontozis2026generalized,
title = {{Generalized myoclonus following dobutamine stress echocardiography: a case report.}},
author = {Anastasios Bontozis and Alexandros Makris and Dimitrios Iliopoulos and Sotirios Kotoulas and Eftyhia Chamodraka},
journal = {European heart journal. Case reports},
year = {2026},
month = oct,
doi = {10.1093/ehjcr/ytag775},
url = {https://europepmc.org/article/MED/42953748},
note = {CC BY},
}
RIS
TY - JOUR
TI - Generalized myoclonus following dobutamine stress echocardiography: a case report.
AU - Anastasios Bontozis
AU - Alexandros Makris
AU - Dimitrios Iliopoulos
AU - Sotirios Kotoulas
AU - Eftyhia Chamodraka
PY - 2026
DA - 2026/10/21
JO - European heart journal. Case reports
DO - 10.1093/ehjcr/ytag775
UR - https://europepmc.org/article/MED/42953748
AB - Dobutamine stress echocardiography (DSE) is a widely used and generally safe non-invasive imaging modality for the assessment of myocardial ischaemia. Adverse effects are predominantly cardiovascular, whereas neurological complications are exceedingly rare. Dobutamine-induced myoclonus (DIM) has only rarely been reported, mainly in patients receiving prolonged dobutamine infusions for heart failure or cardiomyopathy. A 47-year-old woman underwent DSE for evaluation of exertional chest pain. Following completion of a standard dobutamine protocol, she developed generalized rhythmic myoclonic jerks predominantly involving the axial musculature. The patient remained fully conscious and hemodynamically stable throughout the episode. Intravenous diazepam failed to improve symptoms, whereas complete resolution occurred after administration of intravenous valproic acid. Laboratory investigations, including electrolytes, renal function, and thyroid function tests, were normal. Electroencephalography and brain magnetic resonance imaging revealed no abnormalities. No recurrence was observed during hospitalization or follow-up. To our knowledge, this is the first reported case of DIM occurring immediately after DSE. Unlike previously published cases, which predominantly involved patients with chronic kidney disease and developed after prolonged dobutamine exposure, our patient had normal renal function and developed symptoms immediately upon completion of the stress protocol. The pathophysiology remains uncertain, although increased central nervous system exposure to dobutamine has been proposed. Clinicians performing DSE should be aware of myoclonus as a rare but important neurological complication and should consider valproic acid when benzodiazepines fail to achieve symptom control.
SN - 2514-2119
ER -