An 84-year-old male Jehovah’s Witness presented to the emergency department 1 hour after onset of left facial droop and left upper limb weakness. Thrombolytic stroke treatment was commenced as per local thrombolytic protocol with intravenous recombinant tissue plasminogen activator (rtPA) at 2 hours and 25 min following onset of symptoms. Almost immediately after rtPA infusion the patient reported chest pain and had ECG changes consistent with a diagnosis of anterior ST elevation myocardial infarction. At angiogram, a graft study showed severe native coronary artery disease. The left internal mammary artery graft was patent to the left anterior descending artery (LAD); however, the apical LAD was occluded, with the appearance suggestive of embolic occlusion.
- ischaemic heart disease
- unwanted effects / adverse reactions
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Contributors MF: drawing of figure 2; attainment of angiogram imaging; attainment of ECG imaging; prepared the first draft, edited subsequent drafts, submission of article. JHu: significant contribution to draft writing; contacting patient for consent; draft reviewing; case finding of similar cases. JHa: review of draft article; technical input to imaging; analysis of angiogram report. The three authors were involved in the care of the patient and planning case submission.
Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
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