Coronary embolization following inadequate anticoagulation in a patient with prosthetic mitral valve

Abstract

a b s t r a c tCoronary embolization leading to acute myocardial infarction is a rare phenomenon. We present one such case where acute myocardial infarction resulted following inadequate anticoagulation in a patient with a prosthetic mitral valve.Copyright ª 2013, Indian College of Cardiology. All rights reserved.Coronary embolization may be secondary to bacterial endocarditis, rheumatic heart disease (RHD), dilated cardiomyopathy, left atrial myxoma, arrhythmias, myocardial infarction and prosthetic heart valves (PHV). 1 The incidence of coronary embolization leading to myocardial infarction in autopsy series has been reported between 10 and 13%. 2 The following case report discusses a patient who had undergone Mitral Valve Replacement (MVR) several years ago and developed acute myocardial infarction due to inadequate anticoagulation following cessation of oral anticoagulant therapy.A 56 years old female with no traditional risk factors for Coronary Artery Disease and who had undergone Mitral Valve Replacement surgery (using Medtronic Hall valve) for severe mitral regurgitation (secondary to RHD) in 2000 presented to the emergency with severe retrosternal chest pain of 6 h duration. Her heart rate on admission was 108/min, regular, BP 110/60 mm Hg and cardiovascular as well as respiratory system examinations were unremarkable. ECG revealed acute anterolateral wall myocardial infarction. She was in normal sinus rhythm on presentation and throughout her hospital stay. However in view of underlying cardiac status and enlarged LA size, she is a high risk candidate for atrial fibrillation. Echocardiography revealed dilated left atrium (LA ¼ 62 mm), global Left Ventricular (LV) hypokinesia, dilated LV with severe LV systolic dysfunction (LVEF ¼ 15%) and a normally functioning prosthetic valve at the mitral position. Her last Echo done some 8 months ago revealed global LV hypokinesia and LVEF of 30e35% suggestive of postoperative LV dysfunction. Her present Echo revealed LVEF of 15%. In view of underlying global LV hypokinesia it was difficult to