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European Journal of Echocardiography 2004 5(6):469-471; doi:10.1016/j.euje.2004.04.006
© 2004 by European Society of Cardiology
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Copyright © 2004, The European Society of Cardiology

Acute myocardial infarction after a negative dobutamine stress echocardiogram

Abdou Elhendy*, Wilson Ginete, Scott Shurmur and Thomas R. Porter

Department of Internal Medicine, Section of Cardiology, University of Nebraska Medical Center, Omaha, NE 68198-2265, United States

Received 23 February 2004; received in revised form 12 April 2004; accepted after revision 20 April 2004.

* Corresponding author. Tel.: +1-402-559-9265; fax: +1-402-559-8355. aelhendy{at}unmc.edu


  Abstract

Acute myocardial infarction is a rare complication of dobutamine stress echocardiography (DSE). We described angiographic findings of a patient who developed acute inferior ST segment elevation myocardial infarction 2 h after a normal dobutamine stress echocardiogram. The patient failed thrombolysis and underwent coronary angiography, which showed 60% stenosis of proximal right coronary artery with a complex ulcerated lesion and intracoronary thrombus. These findings suggest that myocardial infarction following DSE does not necessarily occur in patients with severe obstructive coronary artery disease. High shear stress may result in destabilization of a complex plaque with subsequent thrombotic occlusion, despite the absence of a flow-limiting lesion at the time of DSE.


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