title: Impending paradoxical embolism presenting as myocardial infarction.
abstract: We present a spectrum of findings with transthoracic echocardiography, coronary angiography, and open surgical exploration in a 54-year-old man who presented with an acute ST segment elevation myocardial infarction and was diagnosed with impending paradoxical emboli. He underwent successful surgical removal of the thrombus.
  
  
  OBJECTIVE
  Impending paradoxical embolism, a biatrial thromboembolus in transit across a patent foramen ovale, is associated with a 20% mortality rate. Very rarely does it present as a ST segment elevation myocardial infarction. The optimal management (medical or surgical) for those who present with it remains a subject of debate, although surgery has been associated with less systemic embolization.
authors.affiliation: Department of Medicine, University of Virginia, Charlottesville, VA, USA ; Division of Cardiology, University of Virginia, Charlottesville, VA, USA.
authors.forename: Denise M
authors.initials: DM
authors.lastname: Dietz
authors.forename: John D
authors.initials: JD
authors.lastname: Cleveland
authors.forename: Kelly G
authors.initials: KG
authors.lastname: Chewning
authors.forename: John M
authors.initials: JM
authors.lastname: Dent
authors.forename: John A
authors.initials: JA
authors.lastname: Kern
authors.forename: Ellen C
authors.initials: EC
authors.lastname: Keeley
keywords: Impending paradoxical emboli; Non-ST elevation myocardial infarction