Stress Testing in Asthma — EECC MCQ

Correct answer: B — Dobutamine stress echocardiography

This patient cannot exercise and has asthma, which is a contraindication to adenosine and regadenoson (both are vasodilator stress agents that can provoke bronchospasm). Dobutamine stress echocardiography is the appropriate pharmacological stress modality as dobutamine works via adrenergic stimulation (increasing HR and contractility) rather than vasodilatation, and is safe in asthma. While CT coronary angiography is first-line for low-intermediate PTP assessment, in patients unable to exercise with contraindications to vasodilator stress agents, dobutamine stress echo provides functional ischaemia assessment. High BMI may reduce echo image quality but does not contraindicate the modality (contrast agents can improve endocardial definition).

Reference: ESC (2024): Guidelines for the Management of Chronic Coronary Syndromes