title: Paradoxical coronary embolism, a rare cause of acute myocardial infarction on positive pressure ventilation.
abstract: A 65-year-old man developed respiratory failure and was admitted to the Intensive Care Unit for positive pressure ventilation and antibiotic and antifungal therapy.There was a sudden deterioration with chest pain, worsening hypoxia and hypotension. Serial electrocardiograms showed new onset right bundle-branch block with developing anterior ST-segment elevation. An urgent coronary angiogram revealed acute occlusion of the left anterior descending artery with a single large distinct thrombus, which was successfully removed with an aspiration catheter. A presumptive diagnosis of paradoxical coronary embolus was made. A short review is provided of this relatively rare clinical entity which has the potential to present in intensive care patients who have an underlying intra-cardiac defect and require positive pressure ventilation. This case emphasises the importance of being aware of less common causes of acute clinical deterioration and electrocardiographic changes in the ventilated patient.
authors.affiliation: Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium. johan.bennett@uzleuven.be
authors.forename: Johan
authors.initials: J
authors.lastname: Bennett
authors.forename: Li
authors.initials: L
authors.lastname: Ong
authors.forename: Colm
authors.initials: C
authors.lastname: Hanratty
mesh_terms: D000368:Aged; D015897:Comorbidity; D054059:Coronary Occlusion / Q000532:radiotherapy; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging; D004562:Electrocardiography; D019320:Embolism, Paradoxical / Q000150:complications* / Q000453:epidemiology; D017809:Fatal Outcome; D006689:Hodgkin Disease / Q000150:complications; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications* / Q000453:epidemiology; D011175:Positive-Pressure Respiration; D011859:Radiography; D012131:Respiratory Insufficiency / Q000453:epidemiology / Q000628:therapy