Coronary embolism

Abstract

Coronary embolism is rare and an uncommon cause of acute myocardial infarction. When I reported my first case in 1953 [1], it was the 54th case published in the literature. Although my case was the fourth diagnosed during life, it was the first case with the shortest survival time among cases of coronary embolism that were correctly diagnosed before death [1].The infrequency of coronary embolism has been attributed to:(1) the discrepancy between the caliber of the aorta and that of the coronary artery, (2) the situation of the coronary arteries at the root of the aorta immediately beyond the aortic valve, (3) the right angle take-off of the coronary arteries from the aorta, (4) the bulk and swiftness of the blood flow in this portion of the aorta, and (5) the fact that the majority of coronary filling occurs during diastole [1].Many more cases of coronary embolism have been reported during the past half of a century due to increased awareness of this condition. There are three types of coronary embolism:(1) direct, (2) paradoxical, and (3) iatrogenic. Each type carries a different diagnostic and therapeutic connotation.

Acute Myocardial Infarction due to Coronary Artery Embolism in a Patient with a Tissue Aortic Valve Replacement

“…3,4 Coronary artery embolism is an uncommon cause of acute myocardial infarction (AMI). 5 Several recent case reports cite prosthetic mechanical heart valves (in the aortic or mitral positions) in the setting of subtherapeutic anticoagulation as the cause of the coronary artery emboli and AMI. [6][7][8][9] Other causes of coronary embolism resulting in AMI include infective endocarditis, 10,11 atrial thrombus in the setting of atrial fibrillation, 12 atrial myxomas, 13 embolism of cotton pledgets following insertion of porcine valve bioprosthesis, 14 calcific emboli from calcific aortic stenosis, 15 and even emboli originating from biologic glues used in surgical repair of acute aortic dissection.…”

An uncommon myocardial infarction

“…It has been speculated that the take-off of the coronary arteries from the aorta immediately beyond the aortic valve and at a right angle attribute to the infrequency of coronary embolism. Additionally the fact that coronary perfusion mainly occurs during diastole might be another reason [4]. Coronary embolism is classified into three types according to pathological mechanism: direct, paradoxical and iatrogenic embolism.…”

“…Coronary embolism is classified into three types according to pathological mechanism: direct, paradoxical and iatrogenic embolism. Direct embolism to the coronary arteries occurs most commonly in patients with aortic valve endocarditis and from thrombotic material on diseased or prosthetic aortic or mitral valves [4]. . The diagnosis of paradoxical embolism is often difficult to prove because of the high prevalence of PFO in individuals without embolic events.…”

Mechanism of Elevated Serum Cardiac Troponin in Acute Pulmonary Embolism

“…Unfortunately, he failed to mention another very important mechanism, namely, paradoxical embolism into the coronary circulation. 2,3 Paradoxical embolism refers to the passage of a thrombus from systemic veins, usually in the lower extremities, to the systemic circulation, usually via a patent foramen ovale, to cause arterial embolism. This unconventional mode of embolization, thus termed paradoxical embolism, was a diagnostic challenge and seldom detected during life until 1976 when I reported 2 cases diagnosed by cardiac catheterization.…”

“…Paradoxical coronary embolism frequently occurs as a complication of acute PE and is neither rare nor benign. 3 It can cause elevation of not only serum cardiac troponin, but also the ST-segment in the right precordial ECG leads. 5,6 It is important to bear this in mind, not only from a diagnostic standpoint, but also for therapeutic purposes.…”