Paradoxical Coronary Artery Embolism ‑ A Rare Cause of Myocardial Infarction Fayaz A. Hakim, Evan P. Kransdorf, Muaz M. Abudiab, John P. Sweeney Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona, USA
ABSTRACT Paradoxical coronary artery embolism is a rare, but often an underdiagnosed cause of acute myocardial infarction. It should be considered in patient who presents with chest pain and otherwise having a low risk profile for atherosclerosis coronary artery disease. We describe a case of paradoxical coronary artery embolism causing ST segment elevation myocardial infarction in a patient with upper extremity venous thrombosis. Echocardiography demonstrated a patent foramen ovale (PFO) with bidirectional shunt. In addition to treatment of acute coronary event closure of the PFO should be considered to prevent a recurrence.
Key words: Coronary artery, embolism, flush occlusion, myocardial infarction, paradoxical How to cite this article: Hakim FA, Kransdorf EP, Abudiab MM, Sweeney JP. Paradoxical coronary artery embolism - A rare cause of myocardial infarction. Heart Views 2014;15:124-6. © Gulf Heart Association 2014.
oronary artery embolism is an established cause of acute coronary syndrome, but paradoxical coronary artery embolism causing myocardial infarction is rare and requires a high degree of clinical suspicion for diagnosis. Recognition of this condition is important as these patients are at risk of future fatal embolic phenomena. A search for venous thrombosis and underlying prothrombotic conditions should be undertaken. Percutaneous device closure of interatrial communication either in the form of patent foramen ovale (PFO) or atrial septal defect (ASD) should be considered to prevent future embolism.
CASE REPORT A 64‑year‑old male with multiple myeloma was admitted for autologous stem cell transplantation. Two weeks previous he was diagnosed with a peripherally inserted central catheter (PICC)‑related right basilic and axillary vein thrombosis [Figure 1a, arrows] complicated by pulmonary embolism that was treated with low molecular weight heparin. During an attempt at PICC removal, the patient coughed and developed sudden severe left‑sided chest pain. An electrocardiogram showed ST segment Address for correspondence: Dr. Fayaz Ahmad Hakim, Mayo Clinic College of Medicine 13400 E Shea Blvd, Scottsdale, Arizona 85259, USA. E‑mail: [email protected]
HEART VIEWS Oct-Dec 14 Issue 4 / Vol 15
elevation in inferior (II, III, and aVF) leads. Cardiac biomarkers were elevated (Troponin‑T 2.230 ng/ml (normal