Acute myocardial infarction secondary to paradoxical embolism

Abstract

Patent foramen ovale is a risk factor for systemic embolic events such as cryptogenic stroke. Far less commonly, patent foramen ovale is associated with non-cerebral systemic embolic events. Paradoxical coronary artery embolism is a rare and underdiagnosed cause of acute myocardial infarction. It should be considered in patients presenting with myocardial infarction and an otherwise low-risk profile for atherosclerotic coronary artery disease. We describe a case of paradoxical coronary artery embolism causing ST elevation myocardial infarction. Echocardiography demonstrated patent foramen ovale with a significant shunt. In addition to the treatment of the acute coronary event, patent foramen ovale closure was performed to prevent recurrent paradoxical embolic events. LEARNING POINTS • Coronary artery embolism is an established cause of acute coronary syndrome, but paradoxical coronary artery embolism causing myocardial infarction is rare and requires a high degree of clinical suspicion for diagnosis. • Recognition of this condition is important as it has an influence on management and prognosis. A search for venous thrombosis and underlying prothrombotic conditions should be undertaken. • Percutaneous device closure of the patent foramen ovale should be considered to prevent future embolic events.