CASE REPORT

Acute myocardial infarction probably caused by paradoxical embolus in a pregnant woman

P Agostoni, G Gasparini, G Destro

Institute of Cardiology, Ospedale Civile Maggiore, University of Verona, Verona, Italy

Correspondence to:
Correspondence to:
Dr P Agostoni
Institute of Cardiology, Ospedale Civile Maggiore, University of Verona, Piazzale A. Stefani 1, 37126 Verona, Italy; agostonipf{at}genie.it

A 19 year old pregnant woman presented to the coronary care unit with an acute anterior myocardial infarction. She was treated with primary percutaneous transluminal coronary angioplasty of the proximal left anterior descending coronary artery. Ultrasound examination showed patent foramen ovale (PFO) and atrial septal aneurysm. The patient was a heterozygote carrier of factor V Leiden. Despite the lack of a clear clue, it was considered that the pathophysiological cause of this infarction was a paradoxical embolus in the left coronary artery. Pregnancy and factor V Leiden carriership are associated with increased risk of venous thromboembolism and the association between PFO and atrial septal aneurysm is a strong risk factor for systemic embolisation.

Keywords: acute myocardial infarction; patent foramen ovale

Abbreviations: LAD, left anterior descending coronary artery; PFO, patent foramen ovale; PTCA, percutaneous transluminal coronary angioplasty; TIMI, thrombolysis in myocardial infarction

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