Dobutamine stress echocardiogram (DSE) is considered a safe and reliable method for screening for underlying myocardial ischaemia. We report a case of a 60-year-old man who developed inferior ST-segment elevation myocardial infarction within 30 minutes of a normal DSE. The patient was found to have a 99% in-stent restenosis in the mid-right coronary artery with significant thrombosis for which successful percutaneous coronary intervention (PCI) was performed. Acute coronary syndrome after a normal DSE has been rarely reported in the literature. The reported cases were found to have obstructive or non-obstructive coronary plaques with overlying thrombus, which suggests plaque destabilisation and rupture as the possible underlying mechanism behind coronary occlusion.
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