ABSTRACT
This is a case report of a 26 years old female who presented in emergency with sudden onset of chest heaviness and dyspnoea. She had suffered a stroke in the past and was treated with anti-tuberculous medication. Her ECG revealed STelevation myocardial infarction and thrombolysis was performed but was unsuccessful. Further workup during in-hospital stay revealed evidence of infective endocarditis and Streptococcus species were isolated. She was started on penicillin and gentamycin with good recovery. This case presented a management problem during initial presentation as there was insufficient data on thrombolysis during such situation. It is also a diagnostic problem as the initial picture was dominated by acute coronary syndrome. There is need to develop consensus based on expert opinion about management in such situations