Acute myocardial infarction shortly after negative exercise test and reperfusion by intracoronary thrombolysis.

Abstract

A 67-year-old man developed an acute myocardial infarction shortly after normal exercise testing. His clinical history and findings from emergency coronary arteriography suggested that coronary artery spasm followed by intraluminal thrombosis might have been responsible for the myocardial infarction. Although intracoronary thrombolysis two hours after the onset of chest pain provided continued patency of an occluded vessel, serial myocardial perfusion scintigraphies documented myocardial injury, which was probably induced by reperfusion, rather than myocardial salvage.

Acute Anteroseptal Myocardial Infarction after a Negative Exercise Stress Test

“…10 Kurata et al described a 67-year-old man with an acute myocardial infarction occurring 10 minutes after a negative EST with total occlusion of the LAD coronary artery on coronary angiography. 11 Intracoronary thrombolysis resulted in the successful opening of the occluded artery without any significant residual stenosis. Kurata et al speculated that a coronary artery spasm at the site of a minor plaque may have triggered the intimal disruption, leading to intraluminal thrombus formation.…”

“…Kurata et al speculated that a coronary artery spasm at the site of a minor plaque may have triggered the intimal disruption, leading to intraluminal thrombus formation. 11 According to Cadroy et al, only strenuous exercise leads to an increased risk of thrombosis in men, as opposed to moderate exercise; furthermore, patients with underlying CAD have a higher risk compared to patients with normal coronary arteries. 12 As such, the authors of the present case report recommend that patients be advised of potential complications and provide informed consent before undergoing an EST.…”

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

“…This patient was successfully treated with thrombolysis followed by thrombus aspiration and balloon angioplasty at a tertiary centre. Other case reports reporting acute MI after negative exercise stress tests were also treated with systemic or intracoronary thrombolysis 3–5. Shah et al reported the case of a 68-year-old man who developed acute STEMI within 6 min of regadenoson infusion during a pharmacological stress test 6.…”

Incidence and predictors of acute coronary syndrome within a year following a negative stress test—a false sense of security: is routine screening any useful?

“…In one instance, a 48-year-old man who presented with left sided chest pain underwent an ETT which was negative for myocardial ischemia, however, he presented 30 minutes later to the emergency department with acute substernal chest pain and was found to have acute antero-septal STEMI on ECG and underwent PCI (11). On another occasion, researchers report a 67-year-old man with acute myocardial infarction which took place 10 minutes after a negative ETT (12).…”