Paradoxical Myocardial Infarction After Thrombolytic Therapy for Acute Ischemic Stroke.

Early reperfusion therapy with tissue plasminogen activator (tPA) for acute ischemic stroke has mortality benefits despite the risks. Myocardial infarction (MI) after the use of thrombolytic therapy is a rare complication. We report a 67-year-old woman with acute stroke who received tPA for acute ischemic stroke and subsequently developed ST elevation MI (STEMI), highlighting a rare and serious complication.

An Unexpected Factor to Wellens Syndrome.

Factor V Leiden deficiency, the most common inherited thrombophilia, is a risk factor for venous thromboembolism in both the heterozygous and homozygous forms. An autosomal dominant genetic condition, the pattern of incomplete penetrance leads to variable manifestations of the disease. The association with arterial thromboembolism remains controversial, with studies indicating modest increases in risk of coronary artery disease, stroke. We present the case of a 53-year-old male with Wellens syndrome, with a history of heterozygous factor V Leiden deficiency and no other risk factors. Coronary angiography found a complete total occlusion of the proximal left anterior descending artery, with established collaterals, ultimately requiring coronary artery bypass graft. Laboratory testing effectively eliminated the presence of any alternative known risk factors for the advanced coronary artery disease. The literature evaluating a possible link between factor V Leiden deficiency and atherosclerosis remain conflicting. Our case highlights a concerning association and need for further studies.