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Wiafe YA, Amponsah GM, Asafu Adjaye Frimpong G, Owusu IK. Progressive Memory Decline in a Patient With Atrial Septal Defect: Case Report and Literature Review. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2023; 16:11795476231176713. [PMID: 37255701 PMCID: PMC10225960 DOI: 10.1177/11795476231176713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 05/01/2023] [Indexed: 06/01/2023]
Abstract
Atrial septal defect (ASD) is a common congenital anomaly that increases the risk of heart failure as well as strokes which can lead to cognitive impairment. The risk of stroke is higher when pulmonary hypertension develops and there is reversal of shunt. Stroke in ASD may be due to paradoxical emboli from the right heart or a left ventricular thrombus which develops as a result of atrial fibrillation, a common arrhythmia in ASD. We present a case of a 32-year-old Ghanaian man with history of ASD who presented with progressive memory loss with magnetic resonance imaging scan of the brain showing multiple infarcts, microvascular disease, and cerebral atrophy.
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Affiliation(s)
- Yaw Amo Wiafe
- Department of Medical Diagnostics, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Gordon Manu Amponsah
- Department of Physiology, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - George Asafu Adjaye Frimpong
- Department of Radiology, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Isaac Kofi Owusu
- Department of Medicine, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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2
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Josephs M, Benonaih-Jumbo DJ, Jeyakanthan T. Myocardial Infarction Due to Paradoxical Thromboembolism Originating From Distal Lower Extremity Deep Vein Thrombosis (LEDVT). Cureus 2023; 15:e34592. [PMID: 36874327 PMCID: PMC9981484 DOI: 10.7759/cureus.34592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2023] [Indexed: 02/05/2023] Open
Abstract
Paradoxical embolism (PDE) originates in the venous system and ends up in the arterial circulation via cardiac or pulmonary shunts. Cases of PDE from venous thrombosis resulting in acute myocardial infarctions (MIs) are seldom reported in the literature. Diagnoses can often be missed if further workups are not pursued in patients without any underlying risk factors for coronary artery disease (CAD). Here, we report a case of a paradoxical embolus that crossed the patent foramen ovale (PFO), causing ST-elevation MI (STEMI) from an embolized venous thrombus originating in the left distal posterior tibial vein.
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Affiliation(s)
- Meagan Josephs
- Internal Medicine, American University of the Caribbean School of Medicine, Cupecoy, SXM
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3
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Pivtsova AM, Shchekochikhin DY, Ognerubov DV, Agadzhanyan AA, Bogdanova AA, Makeev MI, Pevzner DV, Merkulov ЕV, Andreev DA, Gilyarov MY. Embolic myocardial infarction associated with patent foramen ovale: a case series. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2023. [DOI: 10.15829/1728-8800-2023-3352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
A patent foramen ovale (PFO) is a fairly common mild cardiac defect that causes a shunting across the atrial septum. PFO is also a known risk factor for cryptogenic stroke. Much less frequently, PFO is associated with non-cerebral systemic embolic events. The article describes a case series of paradoxical embolism of the coronary arteries (CA), which caused myocardial infarction (MI). The presence of PFO was confirmed by imaging techniques. Subsequently, the patients underwent successful endovascular closure of the PFO. Thus, paradoxical CA embolism is a rare and underdiagnosed cause of acute MI. It should be considered in patients with MI and a low risk of atherosclerotic coronary artery disease. However, in most cases, it is not possible to verify the source of the embolism. The significance of occluder implantation as one of the treatment tactics requires further clarification.
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Affiliation(s)
| | | | | | | | | | - M. I. Makeev
- E.I. Chazov National Medical Research Center of Cardiology
| | - D. V. Pevzner
- E.I. Chazov National Medical Research Center of Cardiology
| | - Е. V. Merkulov
- E.I. Chazov National Medical Research Center of Cardiology
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4
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Borg B, Buttigieg LL, Magri CJ. Paradoxical coronary artery embolisation: an unusual cause of myocardial infarction. Br J Hosp Med (Lond) 2022; 83:1-4. [DOI: 10.12968/hmed.2022.0157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Bernard Borg
- Department of Medicine, Mater Dei Hospital, Msida, Malta
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5
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Recurrent Episodes of Acute Myocardial Infarction Secondary to Paradoxical Coronary Artery Embolism. CARDIOGENETICS 2022. [DOI: 10.3390/cardiogenetics12030023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Coronary artery embolism is a rare cause of acute myocardial infarction, attributed to approximately 10% of all paradoxical embolisms. It is a condition that should be considered in patients who present with chest pain and have a low overall risk of coronary heart disease. A major risk of coronary artery embolism is the existence of a patent foramen ovale (PFO), which can be shown on bubble transthoracic echocardiography. Here we describe a case report of a 68-year-old Caucasian lady who presented with recurrent episodes of myocardial infarction secondary to a paradoxical coronary artery embolism which was likely due to a PFO. We emphasize the need for more research on the role of PFO percutaneous device closure compared to just medical therapy in those with recurrent episodes of acute myocardial infarction secondary to paradoxical coronary artery embolism. This, in turn, should provide clearer guidance in managing such patients with high risk of mortality.
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6
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Jolobe OMP. High prevalence of inferior ST-segment elevation in pulmonary embolism-related paradoxical embolism. QJM 2021; 114:433-434. [PMID: 32790841 DOI: 10.1093/qjmed/hcaa245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- O M P Jolobe
- From the Medical Division, Manchester Medical Society, Simon Building, Brunswick Street, Manchester M13 9PL, UK
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7
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Mridha N, Ward E, Hayman S, Dahiya A, Prasad S. Paradoxical embolism through patent foramen ovale as a cause of myocardial infarction. Med J Aust 2021; 215:68-69.e1. [PMID: 34145590 DOI: 10.5694/mja2.51140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Naim Mridha
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,Griffith University, Gold Coast, QLD, Australia
| | - Eloise Ward
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,University of Queensland, Brisbane, QLD, Australia
| | - Samual Hayman
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,University of Queensland, Brisbane, QLD, Australia
| | - Arun Dahiya
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,Griffith University, Gold Coast, QLD, Australia
| | - Sandhir Prasad
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,University of Queensland, Brisbane, QLD, Australia
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8
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Patent foramen ovale and paradoxical coronary artery embolism: rare event with great clinical relevance. COR ET VASA 2020. [DOI: 10.33678/cor.2019.083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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9
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Zhang J, Patel S, Clavijo L, Laughrun D. Successful Implementation of Extracorporeal Membrane Oxygenation Support as a Bridge to Heart-Lung Transplantation in an Eisenmenger's Syndrome Patient With Paradoxical Coronary Embolism. J Investig Med High Impact Case Rep 2019; 7:2324709619846575. [PMID: 31053036 PMCID: PMC6505230 DOI: 10.1177/2324709619846575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 03/29/2019] [Accepted: 04/02/2019] [Indexed: 11/24/2022] Open
Abstract
We report a case of a 23-year-old female with a history of unrepaired ventricular septal defect and pulmonary arterial hypertension with Eisenmenger's syndrome (ES) presenting with chest pain. Electrocardiography demonstrated new anterior Q waves and anterolateral ST elevations, and coronary angiography revealed a large organized thrombus in the mid-left anterior descending artery consistent with paradoxical coronary embolism. Patient was treated with percutaneous coronary intervention and aggressive anticoagulation management. Intensive care unit course was complicated by respiratory failure requiring intubation due to hospital-acquired pneumonia in the setting of severe pulmonary hypertension. Patient was emergently initiated on veno-venous extracorporeal membrane oxygenation support (ECMO) as a bridge to heart-lung transplantation. After initiation of ECMO, patient displayed significant clinical improvement and underwent successful heart-lung transplantation. This case highlights veno-venous ECMO as a bridge to heart-lung transplantation in acutely decompensated patients with ES, and is the first reported case of paradoxical coronary embolism in a patient with ES.
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Affiliation(s)
- James Zhang
- University of Southern California, Los Angeles, CA, USA
| | - Sumit Patel
- University of Southern California, Los Angeles, CA, USA
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10
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Patent foramen ovale, paradoxical embolism and fatal coronary obstruction. Forensic Sci Med Pathol 2018; 14:258-262. [PMID: 29488057 DOI: 10.1007/s12024-018-9963-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2018] [Indexed: 10/17/2022]
Abstract
A 75-year-old woman was admitted to the emergency room with chest pain and vomiting. An electrocardiogram and laboratory results were suggestive for myocardial infarction of the posterior cardiac wall. Echocardiography was indicative of aortic dissection, and a CT scan of the thoracic arteries showed a massive pulmonary thromboembolism and thrombotic occlusion of the right coronary artery (RCA). The woman died shortly after admission. Autopsy confirmed the presence of thromboemboli in the right pulmonary artery and its lobar branches. Also, the anterior aortic sinus was filled with a 9 cm long thromboembolus that extended into the RCA, making it dilated and completely occluded. Another 3.5 cm long thromboembolus extended from the beginning of the left subclavian artery. A patent foramen ovale (PFO) was present. On the posterior wall of the left ventricle, there was an area suggestive of myocardial infarction, and histopathological examination confirmed that it was 24-48 hours old. The coronary circulation was "co-dominant". The sources of thrombotic masses were the deep veins of the lower limbs. The cause of death was myocardial infarction, caused by RCA occlusion with thromboembolus originating from the deep veins of the left lower leg after paradoxical embolism via PFO. This case illustrates that although deep venous thrombosis, pulmonary thromboembolism, and PFO are not rare findings at autopsy, their combination could be a relatively rare cause of fatal coronary artery occlusion after paradoxical embolism.
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11
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Unique Presentations and Etiologies of Myocardial Infarction in Women. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2017; 19:66. [DOI: 10.1007/s11936-017-0571-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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12
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Aparci M, Uz O, Atalay M, Kardesoglu E. Paradoxical coronary artery embolism due to patent foramen ovale. Int J Cardiol 2016; 209:164. [PMID: 26897073 DOI: 10.1016/j.ijcard.2016.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 02/02/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Mustafa Aparci
- GATA Training and Research Hospital, Department of Cardiology, Istanbul, Turkey.
| | - Omer Uz
- GATA Training and Research Hospital, Department of Cardiology, Istanbul, Turkey.
| | - Murat Atalay
- Izmır Military Hospital, Department of Cardiology, Izmir,Turkey.
| | - Ejder Kardesoglu
- GATA Training and Research Hospital, Department of Cardiology, Istanbul, Turkey.
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13
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Duygu H. Paradoxical coronary embolism as a cause of non-atherosclerotic acute coronary syndrome. Int J Cardiol 2015; 191:225-6. [DOI: 10.1016/j.ijcard.2015.05.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 05/06/2015] [Indexed: 11/30/2022]
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Iannaccone M, Montefusco A, Omede' P, D'ascenzo F, Moretti C. All that glitters ain't gold! A case of embolic STEMI demonstrated by OCT. Int J Cardiol 2015; 196:14-5. [PMID: 26066636 DOI: 10.1016/j.ijcard.2015.05.165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 05/29/2015] [Indexed: 01/08/2023]
Affiliation(s)
- Mario Iannaccone
- Division of Cardiology, Department of Medical Sciences, University of Turin, Italy.
| | - Antonio Montefusco
- Division of Cardiology, Department of Medical Sciences, University of Turin, Italy
| | - Pierluigi Omede'
- Division of Cardiology, Department of Medical Sciences, University of Turin, Italy
| | - Fabrizio D'ascenzo
- Division of Cardiology, Department of Medical Sciences, University of Turin, Italy
| | - Claudio Moretti
- Division of Cardiology, Department of Medical Sciences, University of Turin, Italy
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