Acute myocardial infarction during a dobutamine stress echocardiography, in a patient with angiographically normal coronaries

We report a case of acute myocardial infarction during a dobutamine stress echo (DSE) study in a middle age man. Our patient experienced a severe crushing retrosternal pain at peak DSE study, at the time the ECG recorded an episode of non-sustained ventricular tachycardia followed by a persistent significant ST segment elevation in V2-V6 leads. Symptoms and ECG findings remained despite the use of intravenous (IV) nitrates and therefore thrombolysis was given. A subsequent coronary angiogram revealed only mild atheromatous changes but no stenosis.