What are the odds - Concurrent lower extremity venous thrombosis, pulmonary embolism, septal embolic myocardial infarction and patent foramen ovale

摘要

Cerebral ischemic events are more commonly associated with PFOs than non-cerebral paradoxical systemic events, incidence of latter being only around 5–10% of all paradoxical embolisms. Coronary artery embolism and associated MI is more commonly associated with atrial fibrillation. Its association with a PFO and atrial septal aneurysm has also been reported in small number of cases. Management of acute coronary syndrome from coronary artery embolism is similar to that of atherosclerotic coronary artery disease. There are studies which show decrease in incidence of subsequent ischemic events in patients with cryptogenic strokes and PFO, however is there is no data to suggest such an intervention would be helpful in cases with paradoxical coronary embolism. Our patient is a rare case of a lower extremity DVT leading to concurrent acute PE and NSTEMI from paradoxical embolic occlusion of a septal perforator branch via PFO. By presenting this case, we stress the importance of having a high level of suspicion for coexistence of a PFO and/or atrial septal defect in patients with suspected paradoxical systemic embolism.