Association of a patent foramen ovale with myocardial infarction and pulmonary emboli in a peripartum woman.
Peripartum myocardial infarction is uncommon but devastating in young women. Although it is generally associated with arterial dissection, pregnancy-induced hypercoagulable state can also be a major contributor. Association of patent foramen ovale (PFO) adds to this potential risk. A 29-year-old postpartum female presented with worsening chest pressure, shortness of breath and syncope. She was hypotensive and tachycardic. A ventilation perfusion imaging displayed high probability for pulmonary emboli. With elevated cardiac enzymes and echocardiogram showing wall motion abnormalities, patient underwent percutaneous coronary angioplasty for a midvessel thrombus in the left anterior descending artery. Further workup showed a thrombus straddling into the left atrium via a PFO and a deep venous thrombus in the right iliac vein. Hormonal changes in pregnancy are noted to place young women in a hypercoagulable state. Screening for PFO in this group of patients with timely intervention might prevent a major systemic event caused by paradoxical embolus.
Ramineni
Rajesh
R
Department of Information, University of Miami Miller School of Medicine, Atlantis, FL, USA.
Daniel
George K
GK
D000328:Adult; D017023:Coronary Angiography; D017548:Echocardiography, Transesophageal; D019320:Embolism, Paradoxical / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D011247:Pregnancy; D011644:Puerperal Disorders / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D012307:Risk Factors