A 30-year-old thin male with a clean medical history presented to the Medani Heart Centre (MHC) emergency department with central crushing chest pain that was aggravated by movement and improved by rest. The pain was not associated with cough or shortness of breath, and it was not improved by food or Antacids. Fever, change in appetite, diarrhoea, vomiting, change in urine, headache, or any other neurological symptoms were denied by the patient.
There was no previous history of a similar disease or cardiac issues, though. The patient stated that he is a heavy smoker who has had numerous instances of unprotected sexual intercourse. The patient stated that he did not consume alcohol.
The patient appeared unwell, skinny, and not pale or jaundiced, with a pulse of 110 regular good volume, Bp of 100/60 bilaterally, normal pericardium findings, a clear chest, and a soft abdomen. The ECG revealed significant ST segment elevation from v1 to v6, as well as mild elevation in leads 2, 3 and avF, which was later confirmed by a positive serum troponin as Late Extensive ST segment elevation. Myocardial infarction was crushed by aspirin 300 mg, clopidogrel 600 mg, bisoprolol 2,5 mg, and Enoxaparin inj 0.5mg/kg 12 hourly, and the patient was scheduled for urgent coronary angiography, but during preparation rapid immunochromatographic test for detection of antibodies to Human Immunodeficiency Virus (ICT) tested positive, necessitating confirmation with ELISA, which revealed a high viral load of 22.4 AU/ml (normal up to 1 AU/m). Other tests revealed a normal fasting lipid profile, complete blood count, and electrolyte-based kidney function tests.
With moderately impaired left ventricular systolic function (Ejection Fraction = 34) and anterior, septal, apical, and anterolateral wall hypokinesia, as well as two apical thrombus measures 11×10 cm and 10×12 cm subsequently, and moderately impaired left ventricular systolic function (Ejection Fraction = 34), the decision to add furosemide 40 mg tablets once daily and spironolactone tablets 25 mg. See Fig. 1
The patient was closely monitored symptomatically with serial ECGs on subsequent days, which showed significant improvement until the evening follow-up on day 4 of admission, when he was found to have slurred speech and was unable to move his right side without mouth deviation, headache, or blurring of vision. He was afebrile, conscious, and oriented in time, place, and person during the evaluation. Bulbar cranial nerve affection (without facial palsy), hypotonia on the right side, power grade 3, and hyporeflexia were all present. The patient was taken for an emergency brain CT scan, which revealed infarction in the left parietal area. See Fig. 2
The patient had no previous CT brain since he had never experienced any symptoms or felt the need to do one. Carotid angiography was not performed due to a scarcity of resources. The changes in the CT brain were related to the patient’s stroke symptoms. The patient was observed for the next five days and showed total recovery, with normal tone, power grade 5, and reflexes. After being properly educated on comprehensive anti-ischemic and diuretic therapy with enoxaparin switched to rivaroxaban 15 mg 12 hourly, he was discharged and assigned to the HIV program for proper management, to be examined in the Cardiology Referral Clinic after two weeks.