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Introduction: Dobutamine stress echocardiography (EDobu) is a non invasive examination used to detect myocardial ischemia and to estimate viability. However, it is not without risk. Case report: A 79-year-old patient with cardiovascular risk factors such as type 2 diabetes on oral antidiabetic drugs, hypertension on calcium channel blockers and dyslipidemia on statins, who has been suffering from angina class II of CCS for 5 years. The clinical examination and the ECG of the patient were without particularity. The transthoracic echocardiography was normal, hence the indication for EDobu. At the beginning of the test, the patient was asymptomatic and hemodynamically stable. During the examination, at the beginning of the 30-gamma dobutamin, at the peak of stress, the patient presented typical chest pain with a persistent ST-segment elevation in the inferior territory and kinetic disorders in the same territory. The patient was sent directly to the KT room where a coronary angiography was performed coming back in favor of an occlusion of the proximal right coronary stented successfully. DISCUSSION: Stress echocardiography is the combination of 2D echocardiography with a physical, pharmacological, or electrical stress . The diagnostic endpoint for the detection of myocardial ischaemia is the induction of a transient change in regional function during stress. Serious complications remain exceptional, particularly for stress echo. the occurrence of an acute coronary syndrome during a dobutamine stress echocardiography remains very rare. the incidence of SE-related deaths estimated at < 0.01%, and the incidence of myocardial infarction in the range 0.01-0.1%. Stress Echo may predispose to AMI by either mechanical means by increased shear forces in the coronary artery resulting in plaque disruption or by a biologic process with direct or indirect effects of dobutamine on thrombus formation by a signifiant direct platelet activation. Also, Dobutamine induce an alpha1-mediated coronary vasoconstriction and it is considered a mechanism for developing acute myocardial ischemia. in certain registers such as the POLstress register and the series of cases by and Picano et al and the UK registry, the occurrence of acute coronary syndrome during the stress echo remains rare and does not exceed a value between 0.06 and 9.4% depending on the registers/ Conclusion: EDobu is an important examination in the detection of coronary artery disease that requires close monitoring of the patient and compliance with indications and contraindications.