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Acute myocardial infarction after a negative Dobutamine stress echocardiogram in a patient with end-stage liver disease
Author(s):
1. Khursheed Ahmad: Department of Cardiology, Punjab Institute of Cardiology, Lahore, Pakistan
2. Khurram Shahzad: Department of Cardiology, Punjab Institute of Cardiology, Lahore, Pakistan
3. Muhammad Muzaffar Mahmood: Department of Cardiology, Ittefaq Hospital, Lahore, Pakistan.
Abstract:
Dobutamine stress echocardiogram (DSE) is generally a safe and reliable test for detection of myocardial ischaemia. We report the case of a 43-year-old male with end-stage liver disease (ESLD), who underwent DSE as part of workup for liver transplantation. Although the patient had an uneventful negative DSE, within 45 minutes he developed inferior ST-segment elevation myocardial infarction (STEMI). His coronary angiography showed severe 2-vessel coronary artery disease, which was treated with percutaneous coronary intervention (PCI) with implantation of drug-eluting stents (DES). Acute coronary syndrome (ACS) after a normal DSE has previously been reported in the literature. We describe one such case, with added complexity of managing an ACS in a patient with high bleeding risk. Our case is unique in reporting a STEMI after a negative DSE in a liver transplant recipient. Increased physician awareness of potential complications of DSE is essential to allow timely recognition and management.
Page(s): 905-907
Published: Journal: Journal of Pakistan Medical Association, Volume: 73, Issue: 4, Year: 2023
Keywords:
Myocardial Infarction , Percutaneous coronary intervention , Liver transplant , Dobutamine stress echocardiogram , Endstage liver disease
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