[Myocardial infarct in a young man with angiographically normal coronary arteries and atrial septal defect]

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.