JACC. Case reports · 2025
Paradoxical Embolism Leading to Myocardial Infarction: Revisiting the Significance of Patent Foramen Ovale.
Клинический случайСтатьяНазвание и аннотация: Перевод пока не подготовлен
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Wong Ryan, McClure Trevor, Saleem Danial, Ives Christopher, Salama Amr, Daya Hussein Abu
Аннотация
BACKGROUND: Patent foramen ovale (PFO) is a common anatomic defect, present in about 14% to 35% of the general population. Its clinical significance and management remain unclear in the context of new-onset strokes.
CASE SUMMARY: An 80-year-old woman presented with arm heaviness and calf pain. She was diagnosed with venous, arterial thrombi and type 1 non-ST-segment elevation acute coronary syndrome due to a paradoxical embolus via a PFO, which was medically managed without closure.
DISCUSSION: Current guidelines, based on limited data, provide conditional recommendations for PFO closure in the presence of systemic embolism without a stroke. The decision to medically manage or close a PFO requires further study and should involve shared decision-making.
TAKE-HOME MESSAGES: A high index of suspicion is required to diagnosis PFO-mediated paradoxical emboli. Isolated, distal culprit coronary lesions warrant work-up for nonatherosclerotic causes of myocardial infarction.
CASE SUMMARY: An 80-year-old woman presented with arm heaviness and calf pain. She was diagnosed with venous, arterial thrombi and type 1 non-ST-segment elevation acute coronary syndrome due to a paradoxical embolus via a PFO, which was medically managed without closure.
DISCUSSION: Current guidelines, based on limited data, provide conditional recommendations for PFO closure in the presence of systemic embolism without a stroke. The decision to medically manage or close a PFO requires further study and should involve shared decision-making.
TAKE-HOME MESSAGES: A high index of suspicion is required to diagnosis PFO-mediated paradoxical emboli. Isolated, distal culprit coronary lesions warrant work-up for nonatherosclerotic causes of myocardial infarction.