Autor(es): Ferreira, AR ; Freitas, A ; Magno, P ; Soares, A ; Abreu, PF ; Neves, JP ; Gil, VM
Data: 2013
Identificador Persistente: http://hdl.handle.net/10400.10/1331
Origem: Repositório do Hospital Prof. Doutor Fernando Fonseca
Assunto(s): Paradoxical embolism; Myocardial infarction; Embolia paradoxal; Enfarte do miocárdio
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.
