A 48-year-old man presented to the emergency department with acute onset “crushing” chest pain of approximately 15 minutes duration, associated with diaphoresis and dyspnoea. His cardiovascular risk factors included diabetes mellitus and hypertension. He also underwent living-related renal transplantation in 1990 and 2003 (failure of the first allograft) for end-stage renal failure secondary to IgA nephropathy. He was a non-drinker and did not have a history of gallstone disease. On presentation, the patient was in distress and diaphoretic, but haemodynamic condition was stable. Twelve-lead electrocardiogram (ECG) showed a 1-mm ST-segment elevation in leads II, III, AVF, with reciprocal changes in leads I, AVL (Fig. 1, arrows). A diagnosis of acute inferior ST-segment elevation myocardial infarction was made. In view of the early presentation, fibrinolytic therapy with recombinant tissue plasminogen activator was administered in the emergency department.
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