Paradoxical Embolism Leading to Myocardial Infarction: Revisiting the Significance of Patent Foramen Ovale

Patent foramen ovale (PFO) is a common anatomic defect, present in about 14% to 35% of the general population. Its clinical significance and management remain unclear in the context of new-onset strokes.

An 80-year-old woman presented with arm heaviness and calf pain. She was diagnosed with venous, arterial thrombi and type 1 non-ST-segment elevation acute coronary syndrome due to a paradoxical embolus via a PFO, which was medically managed without closure.

Current guidelines, based on limited data, provide conditional recommendations for PFO closure in the presence of systemic embolism without a stroke. The decision to medically manage or close a PFO requires further study and should involve shared decision-making.

A high index of suspicion is required to diagnosis PFO-mediated paradoxical emboli. Isolated, distal culprit coronary lesions warrant work-up for nonatherosclerotic causes of myocardial infarction.