Acute myocardial infarction with concomitant pulmonary embolism as a result of patent foramen ovale

Hayıroğlu, Mert İlker; Bozbeyoğlu, Emrah; Akyüz, Şükrü; Yıldırımtürk, Özlem; Bozbay, Mehmet; Bakhshaliyev, Nijad; Renda, Emir; Gök, Gülay; Eren, Mehmet; Pehlivanoğlu, Seçkin

doi:10.1016/j.ajem.2014.12.025

Cited by 11 publications

(6 citation statements)

References 12 publications

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“…This is due to the nonspecific presentation associated with acute PE [ 4 ] but it is crucial for optimization of the risk-benefit ratio [ 8 ]. Factors that increase the risk of acute PE include a history of previous thromboembolism, surgery, or major trauma within the preceding month; active cancer; immobilization; estrogen use; tobacco use; chronic pulmonary disease; and chronic heart failure [ 20 , 21 ]. If thrombolytic therapy is provided to an appropriately selected patient in cardiac arrest, ROSC often occurs within minutes [ 10 , 14 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

Massive Pulmonary Embolism Causing Cardiac Arrest Managed with Systemic Thrombolytic Therapy: A Case Report

Welle

Harrison

2021

Am J Case Rep

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Patient: Female, 66-year-old Final Diagnosis: Pulmonary embolism Symptoms: Cardiac arrest Medication: — Clinical Procedure: Thrombolytic therapy Specialty: Critical Care Medicine Objective: Rare disease Background: Approximately 290 000 cases of in-hospital cardiac arrest occur annually, the majority of which are due to cardiac or respiratory causes. Cardiac arrest due to acute pulmonary embolism (PE) is associated with a 90% incidence of mortality and, if identified, it can be treated with systemic thrombolytics. Here, we describe a case in which the outcome for such an event was favorable. Case Report: A 66-year-old woman was admitted with multiple rib and left ankle fractures due to accidental trauma. Before undergoing orthopedic surgery, she experienced a cardiac arrest with pulseless electrical activity, which was witnessed. She had refractory hypoxia and hypotension following intubation and a brief initial return of spontaneous circulation (ROSC) before a second cardiac arrest. A 100-mg bolus dose of systemic thrombolytic therapy was promptly administered, with rapid achievement of sustained ROSC. The results of a subsequent electrocardiogram, echocardiogram, and computed tomography scan further supported the diagnosis of acute PE with right heart strain. Supportive care in the Intensive Care Unit resulted in full neurological recovery and she was discharged to a physical rehabilitation facility 12 days after her cardiac arrest. Conclusions: Systemic thrombolytic therapy is beneficial for cardiac arrest due to acute PE.

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Section: Discussionmentioning

confidence: 99%

Massive Pulmonary Embolism Causing Cardiac Arrest Managed with Systemic Thrombolytic Therapy: A Case Report

Welle

Harrison

2021

Am J Case Rep

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“…However, the co-existence is quite rare. A retrospective analysis of 467 patients revealed a low prevalence of 5.5% of ACS among PE patients, suggesting that patients presenting with initial high pre-test PE probability should be triaged for CTA chest and ECHO [ 19 – 21 ].…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Embolism Presenting as ST-Elevation Myocardial Infarction: A Diagnostic Trap

et al. 2020

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Patient: Male, 50-year-old Final Diagnosis: Submassive pulmonary embolism Symptoms: Chest pain • dyspnea Medication: — Clinical Procedure: Cardiac catheterization Specialty: Cardiology • Critical Care Medicine • Pulmonology Objective: Challenging differential diagnosis Background: The clinical presentation of pulmonary embolism (PE) is highly variable, ranging from no symptoms to shock or sudden death, often making the diagnosis a challenge. An electrocardiogram (EKG) is not a definitive diagnostic tool; however, it can alter the clinical suspicion of acute PE. PE has nonspecific electrocardiographic patterns ranging from a normal EKG in almost 33% of patients to sinus tachycardia, S1Q3T3 pattern (McGinn-White Sign), right axis deviation, and incomplete right bundle branch block (RBBB). ST-segment elevation associated with PE is exceedingly rare, and to date, only a few cases have been reported. Case Report: We present a case of a middle-aged male patient with no medical comorbidities other than obesity, who presented with initial symptoms and EKG findings concerning an ST-elevation myocardial infarction (STEMI). He was later found to have rather patent coronary arteries on cardiac catheterization but bilateral sub-massive pulmonary embolism on computed tomography angiogram (CTA) of the chest. Conclusions: The differential diagnosis of STEMI is broad, including, but not limited to, Prinzmetal’s angina, takotsubo cardiomyopathy, Brugada syndrome, left ventricular aneurysm, hypothermia, hyperkalemia, and acute pericarditis. Pulmonary embolism may present with abnormal EKG and biomarkers that appear to be an acute coronary syndrome, even STEMI. Physicians must maintain a high index of clinical suspicion through risk stratification to identify PE in these settings, as the frequency of such an occurrence is extremely low. A bedside echocardiogram can be an invaluable diagnostic tool in such cases.

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“…Non-atherosclerotic myocardial infarction (MI) is an important but often misdiagnosed cause of acute MI. Furthermore, non-atherosclerotic MI with concomitant acute stroke and pulmonary embolism due to in-transit thrombus across a patent foramen ovale (PFO) is a rare but potentially fatal combination ( 1 , 2 , 3 ). Early detection of this clinical entity can facilitate delivery of targeted therapies and avoid poor outcome ( 1 , 2 ).…”

Section: Discussionmentioning

confidence: 99%

Concomitant acute stroke, pulmonary and myocardial infarction due to in-transient thrombus across a patent foramen ovale

et al. 2018

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Summary Non-atherosclerotic myocardial infarction (MI) is an important but often misdiagnosed cause of acute MI. Furthermore, non-atherosclerotic MI with concomitant acute stroke and pulmonary embolism due to in-transit thrombus across a patent foramen ovale (PFO) is a rare but potentially fatal combination (1, 2, 3). Early detection of this clinical entity can facilitate delivery of targeted therapies and avoid poor outcome (1, 2). Here, we describe a 68-year-old female with hypertension, tobacco abuse and chronic obstructive pulmonary disease presenting with facial droop, right arm weakness and aphasia. Head computed tomography (CT) without contrast was unremarkable. ECG showed an acute inferolateral ST-elevation MI (Fig. 1, Panel A). As patient presented with both an acute neurological deficit and MI, clinical suspicion of non-atherosclerotic MI was raised and the patient underwent concurrent emergency coronary angiography (CAG) and transesophageal echocardiogram (TEE). TEE revealed highly mobile masses in the left and right atrium (Fig. 1, Panel B and Video 1). The large mass (thrombus or cast of a deep venous thrombus) was caught in a PFO (Fig. 1, Panel C, D, E and Videos 2, 3). A second smaller mass/thrombus was seen on the Eustachian valve near the right atrial/inferior vena cava junction (Fig. 1, Panel F and Video 4). CAG confirmed a 100% occluded distal right posterolateral artery suggestive of an embolic phenomenon. The patient underwent successful thrombectomy, retrieving a large thrombus burden (Fig. 1, Panel G and Videos 5, 6, 7). CT angiography showed occluded internal carotid artery (Fig. 1, Panel H). Pathology from thrombectomy confirmed fibrin-rich thrombus. The patient had bilateral lower extremity deep vein thrombosis and bilateral diffuse pulmonary embolisms.

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Acute myocardial infarction with concomitant pulmonary embolism as a result of patent foramen ovale

Cited by 11 publications

References 12 publications

Massive Pulmonary Embolism Causing Cardiac Arrest Managed with Systemic Thrombolytic Therapy: A Case Report

Massive Pulmonary Embolism Causing Cardiac Arrest Managed with Systemic Thrombolytic Therapy: A Case Report

Pulmonary Embolism Presenting as ST-Elevation Myocardial Infarction: A Diagnostic Trap

Concomitant acute stroke, pulmonary and myocardial infarction due to in-transient thrombus across a patent foramen ovale

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