Conservative Acute Management of a Large Paradoxical Coronary Embolism: A Case Report and Systematic Literature...

Coronary embolism is a rare cause of myocardial infarction (MI), often underdiagnosed and lacking standardized treatment guidelines.

A 29-year-old woman with a history of pulmonary embolism presented with acute chest pain and elevated troponins. Coronary angiography revealed a large thrombus in the proximal left anterior descending artery without atherosclerotic disease. Investigations identified a patent foramen ovale (PFO) with bidirectional shunting and thrombophilia. The patient was managed conservatively with anticoagulation and dual antiplatelet therapy, resulting in complete thrombus resolution. PFO closure was performed 6 months later.

Coronary embolism accounts for approximately 9% of MI cases in young adults, with PFO and hypercoagulable states being predisposing factors. Our case demonstrates the efficacy of conservative medical management as a viable initial strategy in hemodynamically stable, asymptomatic young patients with non-flow-limiting coronary embolus with large thrombus burden.

Paradoxical coronary embolism should be considered in young patients presenting with MI. Conservative management with antithrombotic therapy may be an effective acute therapeutic strategy.