A 28 year old white woman had an unplanned home birth due to a short second stage of labour. A healthy boy was delivered vaginally with a midwife in attendance. Before delivering the placenta the patient was given 1 ml of intramuscular Syntometrine (ergometrine maleate 500 μg, oxytocin 5 units; Novartis, Surrey, UK). The placenta and membranes were delivered completely with minimal blood loss. Fifteen minutes later the patient complained of severe central chest tightness radiating to both arms and associated with profuse sweating, nausea, and breathlessness. She was transferred to a local maternity hospital for further assessment.

On admission her ECG showed ST segment elevation across the chest leads with 6 mm of ST elevation in leads V4 and V5 confirming an acute anterior myocardial infarction …