Paradoxical coronary embolism causing non-ST segment elevation myocardial infarction in a case of pulmonary embolism

• Published in: Clinical research in cardiology Vol. 93; no. 10; pp. 824 - 828
• Main Authors: Haghi, D, Sueselbeck, T, Papavassiliu, T, Haase, K K, Borggrefe, M
• Format: Journal Article
• Language: English
• Published: Germany Springer Nature B.V 01-10-2004
• Subjects: Angioplasty, Balloon, Coronary; Coronary Angiography; Coronary artery; Diagnosis; Echocardiography; Echocardiography, Transesophageal; Electrocardiography; Embolism; Embolism, Paradoxical - complications; Embolism, Paradoxical - diagnosis; Embolism, Paradoxical - genetics; Embolisms; Factor V - genetics; Female; Femoral Vein; Health risk assessment; Heart attacks; Heart Septal Defects, Atrial - complications; Heart Septal Defects, Atrial - diagnosis; Heparin - administration & dosage; Humans; Hydroxyethyl starch; Middle Aged; Mutation; Myocardial infarction; Myocardial Infarction - diagnosis; Myocardial Infarction - etiology; Myocardial Infarction - genetics; Myocardial Infarction - therapy; Pulmonary Embolism - diagnosis; Pulmonary Embolism - etiology; Pulmonary Embolism - genetics; Pulmonary embolisms; Saphenous Vein; Signs and symptoms; Thrombophlebitis - complications; Thrombophlebitis - diagnosis; Thrombophlebitis - genetics; Thrombosis; Tomography, X-Ray Computed
• ISSN: 0300-5860; 1861-0684; 1861-0692
• DOI: 10.1007/s00392-004-0130-0

We describe the case of a 61-year-old woman who simultaneously suffered a pulmonary embolism and a myocardial infarction due to paradoxical coronary artery embolism. Transesophageal echocardiography with injection of agitated hydroxyethyl starch revealed a patent foramen ovale. Thrombophlebistis of the left saphenous vein with extension of thrombus into the femoral vein could be identified as the source of embolism. Paradoxical coronary embolism is an underrecognized cause of MI. Diagnosis is particularly difficult, when MI and PE coincide, because of the similarity in clinical signs and symptoms of both entities. A high level of clinical suspicion and echocardiography, especially if performed soon after presentation, can be the clue to early diagnosis of PDE.