title: Transient right-to-left intracardiac shunt following a right ventricular myocardial infarction.
abstract: A 56-year-old smoker presented with a 3-day history of intermittent chest pain. Cardiovascular examination on admission was normal. ECG showed minimal (<1 mm) ST elevation in lead III, and right-sided leads revealed similar mild ST-elevation. Troponin I was elevated at 10.91. He was managed as a delayed-presentation ST-elevation myocardial infarction case. 12 h following admission, he developed oxygen-resistant hypoxia and hypotension. There were no clinical or radiological signs of pulmonary congestion. CT pulmonary angiogram revealed no pulmonary embolus. A bubble-contrast echocardiogram confirmed an active interatrial right-to-left shunt without Valsalva provocation. His hypoxia steadily improved over the following 24 h and he did not require any shunt closure. A repeat bubble contrast echocardiogram showed that the shunt was now only active following a Valsalva manoeuvre. Transoesophageal echocardiography confirmed a patent foramen ovale. This is a rare but important cause of resistant hypoxia following a right-heart infarct.
authors: Department of Cardiology, Chesterfield Royal Hospital, Chesterfield, UK. arvindra@doctors.org.uk
authors: Arvindra
authors: A
authors: Krishnamurthy
authors: Hazel
authors: H
authors: White
authors: Rizwan
authors: R
authors: Ahmed
mesh_terms: D004562:Electrocardiography; D054092:Foramen Ovale, Patent / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D000860:Hypoxia / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications*; D014463:Ultrasonography
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