Paradoxical coronary emboli following a long-haul airline flight.

A 33-year-old man presented with an acute myocardial infarction (MI) after a recent long-haul flight. Angiography revealed thrombus in the right and circumflex coronary artery but no underlying atherosclerosis. Echocardiography revealed the presence of an atrial septal defect (ASD). In view of the recent flight, the presence of an ASD and occlusive thrombi in two coronary arteries, it was considered that the pathophysiological cause was paradoxical embolisation. Transcutaneous device closure of the ASD was implemented to prevent further catastrophic paradoxical embolic events.