Related Experiment Video
Updated: May 18, 2026

Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Myocardial Infarction With PFO: Distinguishing SCAD From Coronary Embolism
Ramkumar Narendran1, Mohammed Ali2, Emanuel Irizarry Berrios1
1Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA.
Background:
Myocardial infarction in young patients without traditional cardiovascular risk factors raises concern for nonatherosclerotic etiologies such as spontaneous coronary artery dissection and coronary embolism.
Case Summary:
A 38-year-old woman with no past medical history presented with acute substernal chest pain associated with nausea and vomiting. Evaluation was consistent with non-ST-segment elevation myocardial infarction (NSTEMI), with dynamic elevation in high-sensitivity troponin levels and ischemic electrocardiographic changes. Transthoracic echocardiography demonstrated mildly reduced left ventricular systolic function with regional wall motion abnormalities not confined to a single coronary distribution as well as a large right-to-left interatrial shunt with atrial septal aneurysm. Coronary angiography identified focal occlusion of a septal perforator branch of the left anterior descending artery. She was managed with guideline-directed NSTEMI therapy and later underwent outpatient patent foramen ovale closure.
Discussion:
This case illustrates the diagnostic complexity of NSTEMI in young patients when angiographic findings and cardiac imaging suggesting nonatherosclerotic etiologies.
Take-Home Message:
NSTEMI in young patients warrants standard acute coronary syndrome management while concurrently evaluating for alternative mechanisms of myocardial injury.
Related Concept Videos
Acute Coronary Syndrome I: Introduction
Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
Pulmonary Embolism I: Introduction
Pulmonary Embolism I: Introduction
Acute Coronary Syndrome III: Diagnostic Studies
Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
