Peripheral thrombosis causing simultaneous saddle pulmonary embolism and paradoxical ST elevation myocardial infarction resulting in cardiovascular collapse.

Paradoxical coronary artery embolism is often an underdiagnosed cause of acute myocardial infarction (MI). It should always be considered in patient with acute MI and a low risk profile for atherosclerotic coronary artery disease. We describe a patient with simultaneous acute saddle pulmonary embolism (PE) and acute ST segment elevation MI due to paradoxical coronary artery embolism. Transoesophageal echocardiography demonstrated a patent foramen ovale with right to left shunt and large saddle PE in the main pulmonary artery and coronary angiography demonstrated acute thrombotic occlusion of the right coronary artery.