A H, a 45 years old patient, with a history of bileaflet prosthetic valve in mitral position, was admitted in the cardiology department for inferior STEMI.
The patient had a history of Acenoucoumarol resistance, and was treated with Fluidone, but he had stopped the treatment since 1 month (not available) and he received instead curative doses of enoxaparin.
The TTE showed good parameters of the prothesis (mean gradiant 5 mmHg, no additional images, no leak), LVEF = 45% and an inferior akinesia).
The coronary angiogram showed normal coronaries, the patient refused the TEE exam!
how to investigate this patient in the Tunisian context?