Concomitant acute myocardial infarction and acute pulmonary embolism caused by paradoxical embolism: a case report

Chen, Weiwei; Yu, Zhixi; Li, Siming; Wagatsuma, Kenji; Du, Beibei; Yang, Ping

doi:10.1186/s12872-021-02123-1

Cited by 6 publications

(5 citation statements)

References 20 publications

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“…The diagnosis of MINOCA should be made in the absence of obstructive (lesion ≥ 50%) coronary artery disease. Coronary artery spasm (CAS) syndrome, coronary dissection, in situ thrombosis [ 3 ], tachycardia, and coronary embolism [ 4 ] are all etiologies that can cause MINOCA. The careful collection of medical history, and specialized examinations such as intracoronary imaging or the ergonovine provocation test, can facilitate the differential diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Nilotinib related acute myocardial infarction with nonobstructive coronary arteries: a case report and literature review

Chen

Liu

et al. 2022

BMC Cardiovasc Disord

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Background Myocardial Ischemia with No Obstructive Coronary Artery Disease (MINOCA) is a common cause of type 2 acute myocardial infarction (AMI) which requires careful differential diagnosis. Coronary artery spasm (CAS) syndrome is one etiology that can lead to MINOCA. Nilotinib, a targeted treatment for chronic myeloid leukemia (CML), has been reported to be related with increased risk of adverse vascular events. Case presentation A 67-year-old male patient was admitted to hospital with acute chest pain. He had a past medical history of CML and a history of treatment with nilotinib for 12 months. Coronary angiography (CAG) showed no significant stenosis. Since the onset of angina was generally in the early morning, and ECG and echocardiography suggested right coronary artery (RCA) disease, an ergonovine provocation test was performed to confirm the diagnosis of CAS. After intracoronary administration of ergonovine, middle and distal RCA showed over 90% vasoconstriction. Nilotinib related MINOCA, CAS and CML were diagnosed. Lifestyle changes (cessation of smoking), anti-spasmodics, statin treatment and adjustment of the nilotinib dose (from 200 mg bid, to 150 mg bid) were recommended for this patient. Six-month’s follow-up showed good recovery with no onsets of angina. Conclusions Physicians should be vigilant to adverse vascular events when treating patients who have been prescribed nilotinib. It is suggested that in patients with MINOCA who have a history of treatment with nilotinib, CAS-induced MINOCA should be included in the differential diagnosis. Further studies are needed to clarify the mechanism and to find better management.

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Section: Introductionmentioning

confidence: 99%

Nilotinib related acute myocardial infarction with nonobstructive coronary arteries: a case report and literature review

Chen

Liu

et al. 2022

BMC Cardiovasc Disord

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“…A retrospective analysis revealed that 34.3% of patients with PE showed ST-segment elevation in the aVR, which must be differentiated from LM or 3-vessel ACS [ 16 ]. Furthermore, reports in the literature indicate that ST-segment elevation in patients with PE can also result from coronary artery embolism secondary to a patent foramen ovale; in such cases, both PE and coronary embolism coexist, leading to ECG changes that reflect the combined effects of these two conditions [ 17 , 18 ]. Certain ECG features associated with PE can predict a worse prognosis.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary embolism in patients with chronic coronary syndrome masquerading as acute coronary syndrome: a case report and literature review

Chen,

Zhu,

Fan

et al. 2024

BMC Cardiovasc Disord

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Background Pulmonary embolisms (PEs) exhibit clinical features similar to those of acute coronary syndrome (ACS), including electrocardiographic abnormalities and elevated troponin levels, which frequently lead to misdiagnoses in emergency situations. Case presentation Here, we report a case of PE coinciding with chronic coronary syndrome in which the patient’s condition was obscured by symptoms mimicking ACS. A 68-year-old female with syncope presented to the hospital. Upon admission, she was found to have elevated troponin levels and an electrocardiogram showing ST-segment changes across multiple leads, which initially led to a diagnosis of ACS. Emergency coronary arteriography revealed occlusion of the posterior branches of the left ventricle of the right coronary artery, but based on the complexity of the intervention, the occlusion was considered chronic rather than acute. On the 3rd day after admission, the patient experienced recurrent chest tightness and shortness of breath, which was confirmed as acute PE by emergency computed tomography pulmonary angiography. Following standardized anticoagulation treatment, the patient improved and was subsequently discharged. Conclusions This case report highlights the importance of recognizing the nonspecific features of PE. Clinicians should be vigilant when identifying other clinical features that are difficult to explain accompanying the expected disease, and it is necessary to carefully identify the causes to prevent missed diagnoses or misdiagnoses.

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“…There have been multiple reports of patients dying from a fatal coronary artery occlusion due to a paradoxical embolism traveling through interatrial communication [ 18 , 19 ]. Additionally, there have been cases of individuals with a PFO who have simultaneous MI from paradoxical emboli and a pulmonary embolism [ 20 , 21 ]. In such patients, it is of even greater importance to discriminate the causes of their symptoms so that the PFO and paradoxical embolism are not missed in the setting of a massive pulmonary embolism.…”

Section: Discussionmentioning

confidence: 99%

Acute Myocardial Infarction in the Setting of Pulmonary Hypertension due to a Patent Foramen Ovale and Paradoxical Embolism

Franke,

Safdar

2024

Case Reports in Pulmonology

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A 67‐year‐old woman with pulmonary hypertension (PH) presented with a 1‐day history of worsening shortness of breath and pleuritic chest pain and was found to have a troponin T level of 3755 ng/L (ref. range 0–19 ng/L). An initial diagnostic workup in the emergency department (ED) led to an urgent left heart catheterization which revealed a 90% occlusive right coronary artery blood clot, even though a recent heart catheterization less than a month prior was completely unremarkable. Further workup led to the discovery of a patent foramen ovale (PFO) and an aneurysmal interatrial septum, suggesting the presence of a paradoxical embolism. While typically asymptomatic, a PFO is an important clinical entity that can lead to irreversible cardiac damage. Suspicion should be high for this finding in the case of an acute myocardial infarction (MI) with no clear cause, especially in a patient with elevated right heart pressures.

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Concomitant acute myocardial infarction and acute pulmonary embolism caused by paradoxical embolism: a case report

Cited by 6 publications

References 20 publications

Nilotinib related acute myocardial infarction with nonobstructive coronary arteries: a case report and literature review

Nilotinib related acute myocardial infarction with nonobstructive coronary arteries: a case report and literature review

Pulmonary embolism in patients with chronic coronary syndrome masquerading as acute coronary syndrome: a case report and literature review

Acute Myocardial Infarction in the Setting of Pulmonary Hypertension due to a Patent Foramen Ovale and Paradoxical Embolism

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