6th May 2025

A 50-year-old man presents to your district general hospital A&E with severe central crushing chest pain in extremis.

A 50-year-old man presents to your district general hospital A&E with severe central crushing chest pain in extremis. On examinations, he has a raised JVP, bibasal crepitations and requires 15 L of oxygen via a non-rebreather mask to maintain saturation of 94%. His ECG shows ST segment elevation and his cardiac troponin test is elevated at 200. You discuss this with the interventional cardiology registrar in a tertiary unit about 6 hours away and you are unable to safely transfer him. A decision is made to thrombolyse this patient. Which of the following is not a contraindication to thrombolysis?

Select the SINGLE most appropriate option from the list below. Select ONE option only.