Inferior wall myocardial infarction haemodynamically complicated by associated Ebstein anomaly

Abstract Ebstein's anomaly is an uncommon cardiac malformation affecting tricuspid valve and right ventricle. We report a case of inferior wall myocardial infarction which was haemodynamically decompensated due to presence of previously undiagnosed Ebstein anomaly. Following aspects of this case makes it a rare presentation. Firstly, presentation of Ebstein anomaly as inferior wall myocardial infarction in a young female with previous two successful pregnancies is uncommon. Paradoxical embolism through a patent foramen ovale could be the most probable aetiology which led to thrombotic right coronary artery occlusion leading to inferior wall and right ventricular myocardial infarction. And, the presence of Ebstein anomaly led to cyanosis and further worsening of haemodynamic status. So, this highlights the importance of early revascularization to salvage myocardium in already congenitally thin and fibrosed ventricles in Ebstein anomaly.