Acute myocardial infarction caused by paradoxical embolism with concomitant pulmonary embolism

Hline, Aye; Malik, Nikesh; Khokhar, Azhar A.; Aggarwal, Rajesh

doi:10.1136/bcr.03.2011.3953

Cited by 12 publications

(8 citation statements)

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“…Such cases accounted for only 2.9% of the referrals to a specialised centre for the evaluation of PFO 5. Such diverse and relatively rarer presentations include acute limb ischaemia,4 6 7 renal infarction,8 9 ischaemia of the digestive tract10 and also myocardial infarction 11 12. Knobloch et al 13 reported a similar case in a young man with myocardial infarction, popliteal artery occlusion and carotid thrombus.…”

Section: Discussionmentioning

confidence: 99%

A unique presentation of four thrombotic events at a time

et al. 2012

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A 72-year-old man was referred to our hospital as a case of postcardiac arrest following a long distance air flight. Work-up in the emergency department revealed the presence of deep vein thrombosis (DVT), bilateral pulmonary embolism, inferior STEMI (ST elevation myocardial infarction) and ischaemic stroke. He received thrombolysis by recombinant tissue plasminogen activator (tPA) following which his haemodynamic status improved, but he developed haemorrhagic transformation of the stroke as a complication. The haemorrhagic lesion gradually resolved with conservative management, leaving behind a residual neurological deficit. His haemodynamic status was stable after the management. Although a diagnosis of right-to-left shunt lesion was highly suggestive in this condition, it could not be confirmed on the transthoracic echocardiogram. Our patient had a unique presentation of multiple thrombi in different organs that caused significant morbidity and haemodynamic instability. There are no well-established guidelines that discuss the acute management of such cases. This situation requires a careful assessment and management of the patient by a multidisciplinary team.

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Section: Discussionmentioning

confidence: 99%

A unique presentation of four thrombotic events at a time

et al. 2012

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“…5,9 These included at least 17 presumed cases of paradoxical coronary embolism, diagnosed post mortem, of which at least five occurred simultaneously with diagnosed pulmonary embolism. [10][11][12][13][14][15] It has been recently suggested that myocardial infarction resulting from paradoxical coronary embolism may be under-diagnosed, in patients with pulmonary embolism a patent foramen ovale. 5 Coronary embolisms have in autopsy series been reported to lodge distally and occur 3-4-times more often in the left than the right coronary artery.…”

Section: Discussionmentioning

confidence: 99%

“…Three cases of successful thrombus aspiration for paradoxical coronary emboli without stenting have been reported previously. [11][12][13] While dual antiplatelet therapy is central in the prevention of stent thrombosis and secondary prevention after myocardial infarction, the current standard in secondary prevention of pulmonary embolism is anticoagulation with warfarin 17 or administration of the novel oral anticoagulants. 18 This is problematic since the combined use of dual antiplatelet therapy and oral anticoagulation (triple antithrombotic therapy), confers substantial risk of bleeding.…”

Section: Discussionmentioning

confidence: 99%

Acute right ventricular failure caused by concomitant coronary and pulmonary embolism: successful treatment with endovascular coronary and pulmonary thrombectomy

Smith

Koul

Roijer

et al. 2013

European Heart Journal: Acute Cardiovascular Care

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IntroductionRespiratory distress and hypoxia in the acute phase of ST-segment elevation myocardial infarction (STEMI) is generally seen in large anterior infarctions resulting in acute heart failure and pulmonary oedema or with acute mechanical complications, including rupture of the ventricular septum, papillary muscle, or free ventricular wall. 1 However, angiographic evidence of occlusion only in smaller coronary branches in conjunction with echocardiography without signs of mechanical complication should lead the clinician to consider concomitant complicating disease. We describe a case of inferolateral STEMI, presenting with chest pain, severe dyspnoea, and hypoxia, related to extensive pulmonary embolism. Case reportA 69-year-old woman presented with sudden onset of severe retrosternal chest pain. She had a history of hypertension and treatment with 5 mg felodipine daily, but had never smoked and was otherwise healthy. An electrocardiogram recorded in the ambulance showed significant ST-segment elevations in inferior (II, aVF, III) AbstractPatent foramen ovale (PFO) is present in approximately 25% of the general population. PFO is characterized by intermittent shunting of blood from the right to the left atrium, especially in the context of increased right-sided filling pressures, with risk of paradoxical embolism. We describe a 69-year-old woman presenting with acute chest pain, severe dyspnoea, and acute inferolateral ST-segment elevation on the electrocardiogram. The patient was diagnosed with myocardial infarction and failure of the right cardiac ventricle, which was considered to be secondary to extensive pulmonary embolism leading to increased filling pressures and paradoxical coronary embolism. The patient underwent emergent percutaneous interventions with coronary thrombus extraction and pulmonary thrombus fragmentation and local thrombolysis. The patient was free of symptoms at follow up 6 months later and echocardiography showed substantially improved right ventricular function. We discuss issues related to the diagnosis, treatment, and secondary prevention for patients with concomitant pulmonary and coronary arterial thrombosis.

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“…The embolisms have preference to be transmitted primarily into the cerebral arteries and there to the posterior vessels [ 2 ]. But we also found a subset of patients with MI caused by this pathophysiology, and associations with thrombophilia, pulmonary embolism (PE) and stroke have been reported [ 5 – 7 ]. Most cases described in literature are presumed with no evidence of actual transit of thrombus across a left-right intracardiac shunt.…”

Section: Discussionmentioning

confidence: 64%

Myocardial Infarction Caused By An Enclosed Thrombus In A Patent Foramen Ovale

Boumaaz¹,

Asfalou²,

Hamami³

et al. 2020

Journal of the Saudi Heart Association

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Paradoxical embolism in coronary artery is a rarely diagnosed clinical entity. In the majority of reported cases; the diagnostic of this pathology is « presumptive » based on certain criteria. It can be considered “proven” when the embolus is found lodged in the abnormal communication between the venous and arterial circulation; which is very rare. We herein report a case of myocardial infarction caused by a proven paradoxical coronary embolism through a patent foramen ovale. The authors highlight through this paper the contribution of echocardiography and particularly trans-esophageal echocardiography, especially if performed soon after presentation, for early diagnosis.

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Acute myocardial infarction caused by paradoxical embolism with concomitant pulmonary embolism

Cited by 12 publications

References 0 publications

A unique presentation of four thrombotic events at a time

A unique presentation of four thrombotic events at a time

Acute right ventricular failure caused by concomitant coronary and pulmonary embolism: successful treatment with endovascular coronary and pulmonary thrombectomy

Myocardial Infarction Caused By An Enclosed Thrombus In A Patent Foramen Ovale

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