title: Acute coronary syndrome of paradoxical origin.
abstract: We describe a rare case of acute myocardial infarction secondary to paradoxical embolism complicating acute pulmonary embolism. A 44-year-old woman presented to the emergency department with chest pain. The physical examination was unremarkable except for oxygen saturation of 75%, and the electrocardiogram showed ST-segment elevation in the inferior leads. Urgent coronary angiography showed a distal occlusion of the right coronary artery and multiple thrombi were aspirated. Despite relief of chest pain and electrocardiogram normalization, her oxygen saturation remained low (90%) with high-flow oxygen by mask. The transthoracic echocardiogram showed a mass in the left atrium and dilatation of the right chambers, while the transesophageal echocardiogram showed a thrombus attached to the interatrial septum in the region of the foramen ovale. Color flow imaging was consistent with a patent foramen ovale. Thoracic computed tomography angiography documented thrombi in both branches of the pulmonary trunk. After five days on anticoagulation, the patient underwent surgical foramen ovale closure.
authors.forename: Ana Rita
authors.initials: AR
authors.lastname: Ferreira
authors.forename: António
authors.initials: A
authors.lastname: Freitas
authors.forename: Pedro
authors.initials: P
authors.lastname: Magno
authors.forename: Ana Oliveira
authors.initials: AO
authors.lastname: Soares
authors.forename: Pedro
authors.initials: P
authors.lastname: Farto e Abreu
authors.forename: José Pedro
authors.initials: JP
authors.lastname: Neves
authors.forename: Victor M
authors.initials: VM
authors.lastname: Gil
mesh_terms: D054058:Acute Coronary Syndrome / Q000209:etiology*; D000328:Adult; D019320:Embolism, Paradoxical / Q000150:complications*; D005260:Female; D006801:Humans