title: Acute myocardial infarction after a negative dobutamine stress echocardiogram.
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 2h 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.
authors.affiliation: Department of Internal Medicine, Section of Cardiology, University of Nebraska Medical Center, Omaha, NE 68198-2265, USA. aelhendy@unmc.edu
authors.forename: Abdou
authors.initials: A
authors.lastname: Elhendy
authors.forename: Wilson
authors.initials: W
authors.lastname: Ginete
authors.forename: Scott
authors.initials: S
authors.lastname: Shurmur
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Porter
mesh_terms: D002316:Cardiotonic Agents / Q000009:adverse effects*; D002637:Chest Pain / Q000188:drug therapy; D004280:Dobutamine / Q000009:adverse effects*; D025401:Echocardiography, Stress / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000188:drug therapy
chemical_list: D002316:Cardiotonic Agents; D004280:Dobutamine