UMEM Educational Pearls

Category: Cardiology

Title: AMI after negative stress test

Keywords: acute myocardial infarction, stress test (PubMed Search)

Posted: 2/24/2008 by Amal Mattu, MD (Updated: 10/20/2020)
Click here to contact Amal Mattu, MD

Just a reminder, after a recent case of a patient that had a large AMI the day after a negative dobutamine stress test...

Neither stress testing nor coronary angiography are definitive for ruling out unstable/vulnerable plaques. If the HPI for your patient is very concerning, don't obviate your concern just because of a recent negative stress test or angiography. These tests are good at identifying large occlusions, but they tell us nothing about recent rupture or about composition of the plaques, and we now know that it is the composition that determines plaque instability. Size doesn't always matter...