Weiwei Chen1,2, Zhixi Yu1,2, Siming Li1,2, Kenji Wagatsuma3, Beibei Du4,5, Ping Yang6,7. 1. Department of Cardiology, China-Japan Union Hospital of Jilin University, Xiantai Street No. 126, Changchun, 130031, Jilin, China. 2. Jilin Provincial Cardiovascular Research Center, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun, 130031, China. 3. Tsukuba Heart Center, Tsukuba Memorial Hospital, Tsukuba, Ibaraki, Japan. 4. Department of Cardiology, China-Japan Union Hospital of Jilin University, Xiantai Street No. 126, Changchun, 130031, Jilin, China. beibeidu2012@jlu.edu.cn. 5. Jilin Provincial Cardiovascular Research Center, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun, 130031, China. beibeidu2012@jlu.edu.cn. 6. Department of Cardiology, China-Japan Union Hospital of Jilin University, Xiantai Street No. 126, Changchun, 130031, Jilin, China. pyang@jlu.edu.cn. 7. Jilin Provincial Cardiovascular Research Center, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun, 130031, China. pyang@jlu.edu.cn.
Abstract
BACKGROUND: Due to its low incidence and diverse manifestations, paradoxical embolism (PDE) is still under-reported and is not routinely considered in differential diagnoses. Concomitant acute myocardial infarction (AMI) and acute pulmonary embolism (PE) caused by PDE has rarely been reported. CASE PRESENTATION: A 45-year-old woman presented with acute chest pain and difficulty with breathing. Multiple imaging modules including ECG, echocardiography, emergency cardioangiogram (CAG), and CT angiography of the pulmonary arteries showed acute occlusion of the posterolateral artery and acute PE. After coronary aspiration, no residual stenosis was observed. One month later, a bubble study showed inter-atrial communication via a patent foramen ovale (PFO). The AMI in this patient was finally attributed to PDE via the PFO. PFO closure was performed, and long-term anticoagulation was prescribed to prevent recurrent thromboembolic events. CONCLUSIONS: PDE via PFO is a rare etiology of AMI, especially in patients with concomitant AMI and PE. Clinicians should be vigilant of this possibility and close the inter-atrial channel for secondary prevention.
BACKGROUND: Due to its low incidence and diverse manifestations, paradoxical embolism (PDE) is still under-reported and is not routinely considered in differential diagnoses. Concomitant acute myocardial infarction (AMI) and acute pulmonary embolism (PE) caused by PDE has rarely been reported. CASE PRESENTATION: A 45-year-old woman presented with acute chest pain and difficulty with breathing. Multiple imaging modules including ECG, echocardiography, emergency cardioangiogram (CAG), and CT angiography of the pulmonary arteries showed acute occlusion of the posterolateral artery and acute PE. After coronary aspiration, no residual stenosis was observed. One month later, a bubble study showed inter-atrial communication via a patent foramen ovale (PFO). The AMI in this patient was finally attributed to PDE via the PFO. PFO closure was performed, and long-term anticoagulation was prescribed to prevent recurrent thromboembolic events. CONCLUSIONS: PDE via PFO is a rare etiology of AMI, especially in patients with concomitant AMI and PE. Clinicians should be vigilant of this possibility and close the inter-atrial channel for secondary prevention.
Authors: Marianna Vachalcová; Monika Jankajová; Marta Jakubová; Karolina Angela Sieradzka; Tibor Porubän; Gabriel Valočik; Peter Šafár; Daniela Ondušová; Ján Petruš; Ingrid Schusterová Journal: J Clin Med Date: 2022-04-05 Impact factor: 4.241