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Dobutamine stress echocardiogram-related in-stent thrombosis with acute myocardial infarction

Puneet Gupta1, Anand Chockalingam1

  • 1Division of Cardiovascular Medicine, University of Missouri Health Care, Columbia, Missouri, USA.

BMJ Case Reports
|January 13, 2019
PubMed

Insights

A normal dobutamine stress echocardiogram (DSE) rarely precedes acute coronary syndrome. This case highlights coronary plaque rupture and thrombosis as a potential cause, even after a negative DSE result.

Area of Science:

  • Cardiology
  • Diagnostic Imaging
  • Interventional Cardiology

Background:

  • Dobutamine stress echocardiogram (DSE) is a standard, safe, and reliable non-invasive test for detecting myocardial ischemia.
  • Acute coronary syndrome (ACS) following a normal DSE is an uncommon clinical event.

Observation:

  • A 60-year-old male presented with inferior ST-segment elevation myocardial infarction shortly after a normal DSE.
  • The patient had a critical 99% in-stent restenosis in the mid-right coronary artery with acute thrombosis.

Findings:

  • Successful percutaneous coronary intervention (PCI) was performed to treat the in-stent thrombosis and restenosis.
  • This case suggests that plaque destabilization and rupture, leading to coronary occlusion, can occur despite a normal DSE.

Implications:

  • Clinicians should maintain a high index of suspicion for ACS in patients with concerning symptoms, irrespective of DSE results.
  • Further research may elucidate mechanisms of ACS post-DSE and refine diagnostic strategies for coronary artery disease.

Keywords:
interventional cardiologyischaemic jeart disease

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