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[Myocardial infarct in a young man with angiographically normal coronary arteries and atrial septal defect]
1Klinika za kardiohirurgiju, Klinicki centar Sarajevo.
Insights
A young man experienced myocardial infarction and ventricular tachycardia despite normal coronary arteries, linked to a large atrial septal defect. Surgical closure of the defect is recommended to prevent future paradoxical emboli and cardiac events.
Area of Science:
- Cardiology
- Cardiovascular Surgery
Background:
- Coronary atherosclerosis accounts for most myocardial infarcts, particularly in younger individuals.
- Alternative causes of myocardial infarction include arteritis, trauma, valvulopathy, systemic diseases, endocarditis, and substance abuse.
Observation:
- A case report details a 34-year-old male presenting with inferior wall myocardial infarction and ventricular tachycardia.
- The patient exhibited normal coronary arteries but had a large atrial septal defect with bidirectional shunting.
- Paradoxical emboli, originating from a cardiac defect, are a recognized cause of infarction.
Findings:
- The atrial septal defect, with potential for right-to-left shunting, is implicated as the cause of paradoxical embolization.
- Surgical intervention for atrial septal defect closure is indicated to prevent recurrent embolic events.
- Echocardiography is crucial for identifying emboli in transit through cardiac defects.
Implications:
- This case highlights the importance of considering congenital heart defects in young patients with myocardial infarction and normal coronaries.
- Closure of atrial septal defects can prevent life-threatening paradoxical emboli and associated neurological or systemic complications.
- Further research into the diagnosis and management of paradoxical emboli is warranted.
Abstract:
The paper is a case report of a 34 year old man with an inferior wall myocardial infarction, episodes of ventricular tachycardia, normal coronary arteries and a large atrial septal defect. Coronary atherosclerosis causes 95% of all myocardial infarcts and 75% in the age group under 35 years. Other possible causes are coronary arteritis, trauma, valuvlopathy, systemic diseases, infective and non-infective endocarditis, polycithemia, thrombocytosis, cocaine abuse. These can be usually excluded by history, physical or laboratory examination. The existence of a large atrial septal defect with dominantly left to right shunting, but occasional right to left shunting, is an indication and a justification for surgical treatment aiming to prevent recurrence by closure of the atrial septal defect. Paradoxical emboli have been recognised in the recent literature as an important cause of cerebral infarction, more rarely of emboli to other locations. The etiology remains difficult to confirm with certitude except when an embolus is seen by echocardiography in transit through a patent foramen ovale. We have also reviewed previously published cases of paradoxical emboli in literature.