Acute coronary syndrome of paradoxical origin

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• 作者：Ana Rita Ferreira ; Ant贸nio Freitas ; Pedro Magno ; Ana Oliveira Soares ; Pedro Farto e Abreu ; Jos茅 Pedro Neves ; Victor M. Gil
• 关键词：Paradoxical embolism ; Patent foramen ovale ; Myocardial infarction
• 刊名：Revista Portuguesa de Cardiologia (English Edition)
• 出版年：October, 2013
• 年：2013
• 卷：32
• 期：10
• 页码：817-821
• 全文大小：1411 K

文摘

We describe a rare case of acute myocardial infarction secondary to paradoxical embolism complicating acute pulmonary embolism. A 44-year-old woman presented to the emergency department with chest pain. The physical examination was unremarkable except for oxygen saturation of 75%, and the electrocardiogram showed ST-segment elevation in the inferior leads. Urgent coronary angiography showed a distal occlusion of the right coronary artery and multiple thrombi were aspirated. Despite relief of chest pain and electrocardiogram normalization, her oxygen saturation remained low (90%) with high-flow oxygen by mask. The transthoracic echocardiogram showed a mass in the left atrium and dilatation of the right chambers, while the transesophageal echocardiogram showed a thrombus attached to the interatrial septum in the region of the foramen ovale. Color flow imaging was consistent with a patent foramen ovale. Thoracic computed tomography angiography documented thrombi in both branches of the pulmonary trunk. After five days on anticoagulation, the patient underwent surgical foramen ovale closure.