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Stress echocardiography is a well established tool in modern cardiology, which increases the diagnostic accuracy of exercise ECG in regards to detection of ischaemia in patients with known or suspected coronary artery disease by 15–20%. Several methods have been introduced to provoke an ischaemia, the most important of which are dynamic exercise using either treadmill or bicycle and pharmacological stimulation with dipyridamole or dobutamine. All of these modalities have a low complication rate, with severe events such as pulmonary oedema, arrhythmia, myocardial infarction or death reported in about 1–3% using the pharmacological approach. However, information regarding complications occurring when stress echocardiography is being performed with the patient in left lateral decubitus supine position is not yet available.
We encountered a 45 year old male patient who developed a unilateral pulmonary oedema immediately following dynamic, bicycle ergometer stress echocardiography. Coronary angiography detected a subtotal restenosis of the right coronary artery, which was immediately dilated, followed by the placement of a 3.0 mm Wiktor stent. The patient was discharged after a negative stress test up to 125 watts. He was clinically stable and asymptomatic.