Paradoxical Coronary Embolism Through a Patent Foramen Ovale Presenting as ST Elevation Myocardial Infarction With
Cristina Suarez Chiriboga1, Tambi Isaac1, Roxana Lazarescu1
1Internal Medicine, Wyckoff Heights Medical Center, New York, USA.
Insights
A 57-year-old man experienced myocardial infarction due to distal coronary artery occlusion. A patent foramen ovale with right-to-left shunting was identified as a potential contributing factor.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- ST-elevation myocardial infarction (STEMI) can have various etiologies.
- Distal coronary artery occlusion without significant atherosclerosis presents a diagnostic challenge.
Abstract:
We report the case of a 57-year-old man presenting with inferior ST elevation myocardial infarction. Initial electrocardiography demonstrated ST segment elevation in the inferior leads. After administration of aspirin and intravenous heparin, repeat electrocardiography showed partial improvement in ST segment elevation. Emergent coronary angiography revealed abrupt distal occlusion of branches of a dominant right coronary artery (RCA) with preserved proximal flow. Intravascular ultrasound (IVUS) demonstrated minimal coronary atherosclerosis without plaque rupture or dissection. Transthoracic and transesophageal echocardiography (TEE) demonstrated a patent foramen ovale with atrial septal aneurysm and right-to-left shunting. Hypercoagulable evaluation was unremarkable. Follow-up echocardiography identified a small left ventricular apical thrombus.
Related Concept Videos
Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
Pulmonary Embolism I: Introduction
Acute Coronary Syndrome I: Introduction
Coronary Circulation
Coronary circulation begins at the base of the aorta, where two main arteries arise—the left and right coronary arteries. These arteries encircle the heart in the coronary sulcus and supply the...
Acute Coronary Syndrome III: Diagnostic Studies
Coronary Artery Disease III: Clinical Manifestations
