title: Acute coronary embolism in a patient with a mechanical aortic prosthesis: case report.
abstract: Embolic myocardial infarction is a rare entity, which is often difficult to diagnose, and there is little agreement on its treatment. Patients with prosthetic valves are considered an important risk group. A 71-year-old woman with a mechanical aortic prosthesis was admitted with anterior ST segment elevation myocardial infarction after two hours of symptoms. Emergency angiography revealed an image suggestive of a large thrombus at the level of the proximal left anterior descending artery. After several attempts to perform thrombus aspiration and balloon dilatation, TIMI 2 flow was obtained. Effective anticoagulation was immediately started and the clinical outcome was favorable. Angiographically normal coronary arteries one year previously, the patient's discontinuation of warfarin and the present angiographic appearance of the culprit lesion suggested an embolic etiology. This cause is often underdiagnosed and associated with ineffective anticoagulation. Its treatment therefore requires educational intervention.
authors.affiliation: Serviço de Cardiologia, Hospitais da Universidade de Coimbra, Coimbra, Portugal. saraiva.fatima@gmail.com
authors.forename: Fátima
authors.initials: F
authors.lastname: Saraiva
authors.forename: Vitor
authors.initials: V
authors.lastname: Matos
authors.forename: Lino
authors.initials: L
authors.lastname: Gonçalves
authors.forename: Luís Augusto
authors.initials: LA
authors.lastname: Providência
mesh_terms: D000208:Acute Disease; D000368:Aged; D003324:Coronary Artery Disease / Q000209:etiology*; D004617:Embolism / Q000209:etiology*; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans