Abstract
Valvular heart diseases and atrial fibrillation are ones of the most common indications for oral anticoagulation, in the same time they are known risk factors for coronary artery disease and presentation of acute coronary syndrome, which may need urgent management by primary percutaneous intervention. Acute myocardial infarction is commonly seen in these patients with suboptimal anticoagulation, but it is almost seldomly seen when anticoagulation is in therapeutic range. This is the first case reporting an acute myocardial infarction (MI) in a patient post mitral valve replacement (MVR) and high International Normalization Ratio (INR), which has not been reported before.
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