CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 1, January–April 2023 52 AFRICA and cerebrovascular adverse events (MACCE) at one year.10 Notably, ischaemic stroke was the most significant contributor to MACCE.6 Our patient was fortunate as he did not suffer any systemic embolisation. In terms of prevention and treatment of LVT in the setting of STEMI, there are no randomised, controlled trials and the 2013 American College of Cardiology Foundation/American Heart Association (ACCF/AHA) guidelines derive from the consensus. The guideline declares that prophylactic oral anticoagulants (OAC) may be administered in the setting of anterior wall apical akinesia/dyskinesia. In addition, the duration of therapy should be limited to three months.12 In comparison, the European Society of Cardiology (ESC) provided no recommendations for prophylaxis in the 2017 STEMI guidelines.13 The ACCF/ Fig. 1. ECG showing STEMI associated with Q waves in the anterior leads (V1–V3), with associated T-wave inversion in the inferolateral leads (II, III, AVF, V4–V6). Fig. 2. Transthoracic and apical four-chamber view showing a large LVT (white arrow) protruding into the LVOT. Fig. 3. 2D TOE 120° three-chamber view showing the LVT (white arrow) protruding into the LVOT.
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