Anterior wall STEMI in a patient with paroxysmal atrial fibrillation due to coronary embolism: A case report. (October 2022)

• Record Type: Journal Article
• Authors: Shah, Newton Ashish; Shah, Sangam; Rijal, Ashes; Chaudhary, Anand; Chand, Swati; Pandey, Shailendra; Rawal, Laba; Parajuli, Suraj; Khanal, Rajaram; Poudel, Chandra Mani
• Is Part Of: Annals of medicine and surgery. Volume 82(2022)
• Publication Date: 2022-10
• Subjects: Atrial fibrillation -- STEMI -- Coronary embolism; Surgery -- Periodicals; Medicine -- Periodicals; General Surgery -- Periodicals; Education, Medical -- Periodicals; Periodicals; 617
• DOI: 10.1016/j.amsu.2022.104602
• Languages: English
• ISSNs: 2049-0801

Abstract

Abstract: Introduction: Coronary embolism (CE) is a rare cause of acute ST-elevation myocardial infarction (STEMI). Atrial fibrillation (AF), left ventricular thrombus, septic emboli from infective endocarditis, myxoma, and paradoxical embolism can induce emboli in coronary arteries. Case presentation: Here we present a case of anterior wall STEMI secondary to paroxysmal AF in a 60-years-old female with a previous history of right-sided ischemic stroke. Discussion: The major criteria for diagnosis of coronary embolism include (1) non-atherosclerotic wall of coronary vessels under angiography; (2) concomitant involvement of multiple sites; (3) histological proof of venous thrombus; (4) imaging by echocardiography/CT/MRI showing intra-cardiac thrombus. The minor criteria include (1) <25% stenosis of other vessels supplying to infarct-free myocardium; (2) atrial fibrillation history; (3) risk factors like (prosthetic valve, bacterial endocarditis, patent foramen ovale, atrial septal defect, dilated cardiomyopathy). Conclusion: Our case highlights the importance of cardiac embolus as a diagnosis in a patient with a history of stroke secondary to atrial fibrillation as a cause of acute STEMI and its management. Highlights: Cardioembolism is an underappreciated etiology of the acute coronary syndrome in the patient with atrial fibrillation. Cardiac embolus may be in a patient with the history of stroke secondary to atrial fibrillation as a cause of acute STEMI.