Paradoxical coronary artery embolism - A rare cause of myocardial infarction

Hakim, Fayaz A.; Kransdorf, E.; Abudiab, Muaz M.; Sweeney, John P.

doi:10.4103/1995-705x.151089

Cited by 18 publications

(19 citation statements)

References 4 publications

(4 reference statements)

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“…[12] A study by Hakim et al (2014) highlighted the importance of having high index of suspicion for paradoxical embolism in patients who have myocardial infarction in the absence of traditional cardiovascular risk factors. [13] This perspective is applicable to our patient despite his presumed genetic predisposition to hypercoagulability. The study asserted that 10–15% of all paradoxical emboli are responsible for paradoxical coronary embolism.…”

Section: Discussionmentioning

confidence: 89%

See 1 more Smart Citation

STEMI and CVA in Hypercoagulable State with Ostium Secundum Defect

Al‐Sadawi

Madoukh²,

Battisha

et al. 2019

AJMCR

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Atrial septal defect (ASD) is a risk factor for multiple vascular thrombotic events, which can occur either sequentially or simultaneously. In this report we present a case of ST-elevation myocardial infarction (STEMI) and cerebrovascular accident (CVA). The severity of adverse cardiovascular or cerebrovascular events can be increased by the presence of specific type of ASD, such as a patent foramen ovale (PFO) or osteum secundum defect. This case report discusses a unique presentation of a 48-year old male on warfarin therapy for a history of cerebral venous thrombosis (CVT) who subsequently presented with simultaneous STEMI with CVA, and who was incidentally found to have an ostium secundum defect on echocardiography. He was emergently taken for cardiac catheterization, which revealed significant proximal LAD occlusion. There has been a long standing debate within the international scientific communities regarding the therapeutic benefit of PFO closure for long-term secondary prevention of recurrence CVA. We discuss the different points of view regarding PFO closure for secondary prevention of CVA with a review of the literature on this rather controversial topic.

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Section: Discussionmentioning

confidence: 89%

“…The study asserted that 10–15% of all paradoxical emboli are responsible for paradoxical coronary embolism. [13]…”

Section: Discussionmentioning

confidence: 99%

STEMI and CVA in Hypercoagulable State with Ostium Secundum Defect

Al‐Sadawi

Madoukh²,

Battisha

et al. 2019

AJMCR

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“…1 Paradoxical coronary embolism is rare and accounts for only 10% to 15% of paradoxical emboli events. 2 It should be suspected in young individuals at low risk for atherosclerotic disease and without other risk factors for coronary thrombosis such as oral contraceptive use and polycythemia. The management of paradoxical coronary embolism is highlighted in this case, which includes aspiration thrombectomy with or without angioplasty and aggressive anticoagulation management.…”

Section: Discussionmentioning

confidence: 99%

Successful Implementation of Extracorporeal Membrane Oxygenation Support as a Bridge to Heart-Lung Transplantation in an Eisenmenger’s Syndrome Patient With Paradoxical Coronary Embolism

Zhang

Patel

Clavijo

et al. 2019

Journal of Investigative Medicine High Impact Case Reports

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We report a case of a 23-year-old female with a history of unrepaired ventricular septal defect and pulmonary arterial hypertension with Eisenmenger’s syndrome (ES) presenting with chest pain. Electrocardiography demonstrated new anterior Q waves and anterolateral ST elevations, and coronary angiography revealed a large organized thrombus in the mid-left anterior descending artery consistent with paradoxical coronary embolism. Patient was treated with percutaneous coronary intervention and aggressive anticoagulation management. Intensive care unit course was complicated by respiratory failure requiring intubation due to hospital-acquired pneumonia in the setting of severe pulmonary hypertension. Patient was emergently initiated on veno-venous extracorporeal membrane oxygenation support (ECMO) as a bridge to heart-lung transplantation. After initiation of ECMO, patient displayed significant clinical improvement and underwent successful heart-lung transplantation. This case highlights veno-venous ECMO as a bridge to heart-lung transplantation in acutely decompensated patients with ES, and is the first reported case of paradoxical coronary embolism in a patient with ES.

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“…However, even in an era of widespread use of antibiotics, coronary emboli from IE do still occur, and can present as ST-elevation myocardial infarction [25]. Studies have shown microemboli in the coronary arteries in 60% of patients with IE [25][26][27].…”

Section: Streszczeniementioning

confidence: 99%

“…The diagnosis of IE has serious implications for the proper choice of therapeutic method in case of CE. There are several reports that warn about use of thrombolysis for AMI associated with endocarditis, due to risk of fatal intracranial bleeds and massive gastrointestinal bleeding [25][26][27][28][29].…”

Section: Streszczeniementioning

confidence: 99%

Coronary embolism causing acute myocardial infarction. Review of the literature

Zachura¹,

Piątek²,

Kurzawski³

et al. 2016

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Coronary artery embolism (CE) should be considered as a nonatherosclerotic cause of acute myocardial infarction (AMI), especially in patients with conditions favouring the formation of intracardiac thrombi. The main aetiologies of CE have changed in recent decades. Currently, atrial fibrillation is the most common cause. Most studies on CE infarcts are case reports with small numbers of patients. There are still no clear guidelines for the management in embolic myocardial infarction. Depending on the aetiology, the treatment needs to be tailored individually. As long-term outcomes indicate, patients with CE causing AMI are at high-risk and therefore require close follow-up. StreszczenieZator tętnicy wieńcowej należy podejrzewać w przypadku ostrego zespołu wieńcowego u pacjentów bez choroby miażdży-cowej, ale z czynnikami ryzyka sprzyjającymi powstawaniu skrzeplin wewnątrzsercowych. Najważniejsze etiologie zatoru tętnic wieńcowych zmieniały się w ciągu ostatnich dekad. Obecnie za najczęstszą przyczynę uznaje się migotanie przedsionków. Większość prac na temat zawałów spowodowanych zatorem tętnicy wieńcowej to opisy przypadków z niewielką liczbą przedstawionych pacjentów. Niestety nadal nie ma jasnych wytycznych co do diagnostyki oraz leczenia zatoru tętnic wieńcowych. W zależności od etiologii leczenie powinno być dopasowane indywidualnie. Jak wskazują wyniki długoter-minowych obserwacji, pacjenci z zawałem w wyniku zatoru tętnicy wieńcowej stanowią grupę wysokiego ryzyka, która wymaga dokładnej obserwacji.Approximately 5% of all patients with acute myocardial infarction (AMI) do not have atherosclerotic coronary artery disease [1]. Coronary artery embolism (CE) should be suspected in patients with factors or comorbidities predisposing to embolic events, who develop severe chest pain with elevated cardiac enzymes. Large diversity of aetiologies makes the precise diagnosis challenging. Most studies on coronary artery embolic infarcts are case reports with a small number of patients. There are still no clear guidelines for diagnostic criteria and the management of such cases. The approach of this paper is to provide a literature review of the CE causing AMI.Results from research by Prizel et al. revealed the incidence of coronary artery embolic infarcts in 55 out of 419 patients, which comprised 13% of autopsy-studied infarcts [2]. In another recent mechanistic study, based on analysis of 1776 patients with de novo AMI, the prevalence of CE was 2.9% [3]. The growing importance of invasive diagnostic and therapeutic methods provides a wealth of information about CE and its aetiology. There are a number of causes of coronary artery embolism. Analysis of the four main autopsy studies reported in the literature [4][5][6] with additional recently published mechanistic study [3], shows how the aetiology of CE has varied over the last half-century. Initially infective endocarditis accounted for more than half of all cases, then with the widespread use of antibiotics non-infected valvular heart disease became more ...

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Paradoxical coronary artery embolism - A rare cause of myocardial infarction

Cited by 18 publications

References 4 publications

STEMI and CVA in Hypercoagulable State with Ostium Secundum Defect

STEMI and CVA in Hypercoagulable State with Ostium Secundum Defect

Successful Implementation of Extracorporeal Membrane Oxygenation Support as a Bridge to Heart-Lung Transplantation in an Eisenmenger’s Syndrome Patient With Paradoxical Coronary Embolism

Coronary embolism causing acute myocardial infarction. Review of the literature

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