Liver transplantation (LT) improves outcomes and quality of life in patients with end-stage liver disease (ESLD). As a result of improved accessibility and recipient survival, transplant candidates are becoming increasingly older, have more comorbidities, and experience more long-term complications, all of which create new challenges in post-transplantation care. In the post-transplant period, a multitude of factors can influence cardiovascular risk in transplant recipients due to aggravation in recipient populations from new-onset dyslipidaemia, hypertension, glucose intolerance, and nephrotoxicity as side effects of immunosuppressive agents. Traditional cardiovascular risk factors are becoming increasingly prevalent in the ageing population of liver transplant candidates, and coronary artery disease (CAD) is considered to be more common than previously thought. Cardiovascular events are recognised as prominent causes of early and late mortality in liver transplant recipients. The most common cardiovascular diseases in transplant candidates are ischaemic CAD and cardiomyopathy. We describe a complex case of a liver transplant recipient in a 50-year-old male patient with no known history of CAD who developed progressive acute myocardial infarction within 6 months of liver transplant and was ultimately thrombolysed to optimise myocardial perfusion. Management of myocardial ischaemia is complicated by a high risk of bleeding in the setting of coagulopathy. Once thrombolysis and haemodynamic stability were achieved, the patient was immediately shifted for coronary angiography, and staged coronary angioplasty was performed for triple vessel coronary disease in the patient at the cardiac institute.