Successful removal of a paradoxical coronary embolus using an aspiration catheter.

BACKGROUND: A 28-year-old man presented at hospital with persistent pain in his chest and left arm, a paced rhythm on electrocardiography and elevated levels of cardiac enzymes. He was known to have patent foramen ovale and a dual-chamber pacemaker, which had been implanted following electrophysiological ablation to treat supraventricular tachycardia 3 years previously. The patient did not have a history of cardiovascular risk factors, recent travel, immobilization or clinical features of infection, and he was not taking any medication. INVESTIGATIONS: Electrocardiography, cardiac enzyme studies, coronary angiography and transthoracic echocardiography. DIAGNOSIS: Acute myocardial infarction, paradoxical coronary embolus and patent foramen ovale. MANAGEMENT: Coronary aspiration embolectomy and systemic anticoagulation.