Acute myocardial infarction after a negative Dobutamine stress echocardiogram in a patient with end-stage liver disease Authors Khursheed Ahmad Department of Cardiology, Punjab Institute of Cardiology, Lahore, Pakistan Khurram Shahzad Department of Cardiology, Punjab Institute of Cardiology, Lahore, Pakistan Muhammad Muzaffar Mahmood Department of Cardiology, Ittefaq Hospital, Lahore, Pakistan DOI: https://doi.org/10.47391/JPMA.5498 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. Downloads Full Text Article Published 2023-03-15 How to Cite Ahmad, K., Shahzad, K., & Muhammad Muzaffar Mahmood. (2023). Acute myocardial infarction after a negative Dobutamine stress echocardiogram in a patient with end-stage liver disease. Journal of the Pakistan Medical Association, 73(4), 905–907. https://doi.org/10.47391/JPMA.5498 More Citation Formats ACM ACS APA ABNT Chicago Harvard IEEE MLA Turabian Vancouver Download Citation Endnote/Zotero/Mendeley (RIS) BibTeX Issue Vol. 73 No. 4 (2023): April Section Case Report License Copyright (c) 2023 Journal of the Pakistan Medical Association This work is licensed under a Creative Commons Attribution 4.0 International License.