A case of acute pulmonary embolism and acute myocardial infarction with suspected paradoxical embolism after laparoscopic surgery

Uchida, Shunya; Yamamoto, Mika; Masaoka, Yoshiko; Mikouchi, Hiroshi; Nishizaki, Yoshitomo

doi:10.1007/bf02482307

Cited by 28 publications

(18 citation statements)

References 8 publications

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“…Indeed, reports of MI as a result of paradoxical embolism are sporadic in the literature. [12][13][14][15] Three criteria for the confident diagnosis of paradoxical embolism are frequently cited: 1) arterial embolism with no evidence of a source in the left heart or arterial circulation, 2) evidence of an abnormal communication between the right and left circulations, and 3) confirmation of deep venous thrombosis or pulmonary embolism. Paradoxical embolism can be considered proved only when the embolus is found located in the abnormal communication between venous and arterial circulation (the so-called impending paradoxical embolism).…”

Section: Discussionmentioning

confidence: 99%

Acute Myocardial Infarction in a Child: Possible Pathogenic Role of Patent Foramen Ovale Associated With Heritable Thrombophilia

Coppola

Agnetti²,

Hagler

et al. 2004

Pediatrics

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ABSTRACT. We report an 8-year-old girl who presented with clinical features of an acute myocardial infarction. The angiographic appearance of the coronary arteries was normal. A thrombophilic state caused by a homozygote genotype for the prothrombin G20210A mutation was detected, and a patent foramen ovale (PFO) with right-to-left shunting after Valsalva maneuver was demonstrated by transesophageal contrast echocardiography. No other embolic source was identified. We suggest that paradoxical embolization through a PFO resulted in a myocardial infarction in this young patient with hereditary thrombophilia. We closed the patient's PFO with a 25-mm PFO occluder. She was anticoagulated with warfarin for 6 months. S tudies of cryptogenic stroke in young patients have shown that the incidence of patent foramen ovale (PFO) is higher than in patients with established causes of stroke. [1][2][3][4][5] The suggested mechanism for a cerebrovascular event in patients with a PFO is based on a transient increase in right heart pressure, which would cause a transient right-to-left shunt through the PFO, with the possibility that a venous embolus could cross the PFO and embolize the cerebral circulation (paradoxical embolism). Paradoxical emboli could also reach other vascular beds, such as the coronary arteries, and cause acute myocardial infarction (MI). 6 Recent studies have shown that genetic or acquired prothrombotic disorders may represent risk factors for thromboembolic disease also in children. [7][8][9] We report a case of acute MI in an 8-year-old girl in whom, because of the presence of a PFO and inherited prothrombotic abnormality, after excluding all other possible causes, we presume that the MI had been caused by a paradoxical embolism. CASE REPORTSThis 8-year-old girl, who previously had been well except for asthma and allergic rhinitis and conjunctivitis caused by pollen allergy, experienced acute chest pain, localized at the sternal area, while she was playing basketball at school. She stopped playing and the pain disappeared within 20 minutes. Her mother arrived when the pain had already ceased and noted that she was pale. In the evening, she developed a mild fever. On the following day, she awoke early in the morning because of a severe precordial pain. She stated that the pain felt like a weight pushing on her chest. The girl appeared extremely ill, pale, and sweaty; therefore, she was taken to the local hospital. On admission, the pain had persisted for ϳ45 minutes, but the intensity had decreased. The pain disappeared completely in 1 hour. Physical examination did not reveal any abnormality, heart rate was 96 beats/min, blood pressure was 105/60 mm Hg, respiratory rate was 20 breaths/min, and transcutaneous oxygen saturation was 97%. The electrocardiogram (ECG) showed a sinus rhythm with 2.5-mm ST elevation in lead I, aVL, V 4 , V 5 , and V 6 and ST depression in V 1 , V 2 , and aVR (Fig 1). The markers of myocardial damage were significantly increased: myoglobin was 224 ng/mL (normal values: 0 -70 ng/mL),...

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Section: Discussionmentioning

confidence: 99%

Acute Myocardial Infarction in a Child: Possible Pathogenic Role of Patent Foramen Ovale Associated With Heritable Thrombophilia

Coppola

Agnetti²,

Hagler

et al. 2004

Pediatrics

View full text Add to dashboard Cite

show abstract

“…5,9 These included at least 17 presumed cases of paradoxical coronary embolism, diagnosed post mortem, of which at least five occurred simultaneously with diagnosed pulmonary embolism. [10][11][12][13][14][15] It has been recently suggested that myocardial infarction resulting from paradoxical coronary embolism may be under-diagnosed, in patients with pulmonary embolism a patent foramen ovale. 5 Coronary embolisms have in autopsy series been reported to lodge distally and occur 3-4-times more often in the left than the right coronary artery.…”

Section: Discussionmentioning

confidence: 99%

Acute right ventricular failure caused by concomitant coronary and pulmonary embolism: successful treatment with endovascular coronary and pulmonary thrombectomy

Smith

Koul

Roijer

et al. 2013

European Heart Journal: Acute Cardiovascular Care

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IntroductionRespiratory distress and hypoxia in the acute phase of ST-segment elevation myocardial infarction (STEMI) is generally seen in large anterior infarctions resulting in acute heart failure and pulmonary oedema or with acute mechanical complications, including rupture of the ventricular septum, papillary muscle, or free ventricular wall. 1 However, angiographic evidence of occlusion only in smaller coronary branches in conjunction with echocardiography without signs of mechanical complication should lead the clinician to consider concomitant complicating disease. We describe a case of inferolateral STEMI, presenting with chest pain, severe dyspnoea, and hypoxia, related to extensive pulmonary embolism. Case reportA 69-year-old woman presented with sudden onset of severe retrosternal chest pain. She had a history of hypertension and treatment with 5 mg felodipine daily, but had never smoked and was otherwise healthy. An electrocardiogram recorded in the ambulance showed significant ST-segment elevations in inferior (II, aVF, III) AbstractPatent foramen ovale (PFO) is present in approximately 25% of the general population. PFO is characterized by intermittent shunting of blood from the right to the left atrium, especially in the context of increased right-sided filling pressures, with risk of paradoxical embolism. We describe a 69-year-old woman presenting with acute chest pain, severe dyspnoea, and acute inferolateral ST-segment elevation on the electrocardiogram. The patient was diagnosed with myocardial infarction and failure of the right cardiac ventricle, which was considered to be secondary to extensive pulmonary embolism leading to increased filling pressures and paradoxical coronary embolism. The patient underwent emergent percutaneous interventions with coronary thrombus extraction and pulmonary thrombus fragmentation and local thrombolysis. The patient was free of symptoms at follow up 6 months later and echocardiography showed substantially improved right ventricular function. We discuss issues related to the diagnosis, treatment, and secondary prevention for patients with concomitant pulmonary and coronary arterial thrombosis.

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“…34 Uchida and colleagues described a case of a 58-year-old man who developed PE and an acute MI simultaneously after laparoscopic surgery. 38 These 3 shortly characterized cases illustrate the difference of the time frame between PE and MI symptoms onset, focusing attention on the similarity in clinical signs and symptoms of both entities and emphasizing the difficulties in diagnosis making when they coincide.…”

Section: Paradoxical Embolism As a Probable Cause Of Acute Coronary Smentioning

confidence: 99%

Unique Case of ST-Segment–Elevation Myocardial Infarction Related to Paradoxical Embolization and Simultaneous Pulmonary Embolization

et al. 2015

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1214 Foreword Information about a real patient is presented in stages (boldface type) to an expert clinician (Dr Wąsek), who responds to the information, sharing his reasoning with the reader (regular type). A discussion by the authors follows.A 69-year-old man with no history of cardiac disease collapsed at home shortly after chest pain appearance. The ECG performed by paramedics during transportation and sent by the LifeNet system for evaluation to the Cardiology Center shows atrial fibrillation (AF) with a regular slow rhythm of 50 beats/min, suggesting complete heart block, ST-segment elevation in inferior and precordial V3 through V6 leads, ST-segment depression in aVL and in precordial V1 to V2 leads ( Figure 1A). The clinical presentation and ECG allow for the diagnosis of ST-segmentelevation myocardial infarction (STEMI) and the patient receives aspirin 300 mg, clopidogrel 600 mg, unfractionated heparin 5000 IU, and morphine 5 mg IV on the way to the hospital. Within 3 hours after the onset of chest pain, the patient is presented to the emergency department of the nearest hospital with a 24/7 cardiac catheterization facility. Dr Wąsek:The clinical presentation and ECG are consistent with acute myocardial infarction (MI) with persistent ST-segment elevation. Networking with the mobile emergency unit, prehospital medical treatment, and invasive strategy implementation within the recommended timelines are in agreement with the current guidelines.1 Although prasugrel or ticagrelor should preferably be used, in this particular case, clopidogrel seems to be a better option in terms of safety, considering the risk of bradycardia recurrence and possible risk of bleeding following faint and head injury. Dr Wąsek: The ECG tracing is the key element in diagnosis and proper treatment initiation at this stage. It leads to immediate coronary catheterization and invasive restoration of flow in the case of the occlusion. Any delay in the initiation of treatment at this stage should be avoided. A careful physical examination is needed, but it should be restricted and focused on the presence of possible mechanical complications of MI and the probable presence of different life-threatening diseases mimicking STEMI. From this perspective, the decision to postpone the head skin cut suture is rational; however, careful neurological examination in this case is mandatory because of the history

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A case of acute pulmonary embolism and acute myocardial infarction with suspected paradoxical embolism after laparoscopic surgery

Cited by 28 publications

References 8 publications

Acute Myocardial Infarction in a Child: Possible Pathogenic Role of Patent Foramen Ovale Associated With Heritable Thrombophilia

Acute Myocardial Infarction in a Child: Possible Pathogenic Role of Patent Foramen Ovale Associated With Heritable Thrombophilia

Acute right ventricular failure caused by concomitant coronary and pulmonary embolism: successful treatment with endovascular coronary and pulmonary thrombectomy

Unique Case of ST-Segment–Elevation Myocardial Infarction Related to Paradoxical Embolization and Simultaneous Pulmonary Embolization

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