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Paradoxical coronary embolism causing non-ST segment elevation myocardial infarction in a case of pulmonary embolism

Gleichzeitiges Auftreten von Lungenembolie und Nicht-ST-Elevationsinfarkt bei paradoxer Embolie

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Zusammenfassung.

Wir berichten über eine 61-jährige Patientin, bei der es, bedingt durch eine paradoxe Embolie, zum zeitgleichen Auftreten einer Lungenembolie und eines akuten Myokardinfarktes kam. Mittels transösophagealer Echokardiographie mit Injektion von aufgeschäumter Hydroxyethylstärke konnte ein offenes Foramen ovale nachgewiesen werden. Als Emboliequelle fand sich eine Thrombophlebitis der Vena saphena magna mit Thrombuspropagation in die Vena femoralis. Paradoxe Koronararterienembolien sind eine seltene, aber häufig unerkannte Ursache eines akuten Myokardinfarktes. Gleichzeitiges Vorliegen einer Lungenembolie erschwert ihre Diagnose weiter, da sich Symptome und klinische Zeichen beider Erkrankungen ähneln. Besondere Aufmerksamkeit und eine frühzeitige Echokardiographie können entscheidende Hinweise zur frühen Diagnose liefern.

Summary.

We describe the case of a 61-year-old woman who simultaneously suffered a pulmonary embolism and a myocardial infarction due to paradoxical coronary artery embolism. Transesophageal echocardiography with injection of agitated hydroxyethyl starch revealed a patent foramen ovale. Thrombophlebistis of the left saphenous vein with extension of thrombus into the femoral vein could be identified as the source of embolism. Paradoxical coronary embolism is an underrecognized cause of MI. Diagnosis is particularly difficult, when MI and PE coincide, because of the similarity in clinical signs and symptoms of both entities. A high level of clinical suspicion and echocardiography, especially if performed soon after presentation, can be the clue to early diagnosis of PDE

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Authors and Affiliations

  1. I. Medizinische Klinik, Universitätsklinikum Mannheim, 68167, Mannheim, Germany

    D. Haghi

  2. I. Medical Department, University Hospital Mannheim, Mannheim, Germany

    T. Sueselbeck,  T. Papavassiliu,  K. K. Haase &  M. Borggrefe

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  1. D. Haghi
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  2. T. Sueselbeck
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  3. T. Papavassiliu
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  4. K. K. Haase
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  5. M. Borggrefe
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Correspondence to D. Haghi.

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Haghi, D., Sueselbeck, T., Papavassiliu, T. et al. Paradoxical coronary embolism causing non-ST segment elevation myocardial infarction in a case of pulmonary embolism. Z Kardiol 93, 824–828 (2004). https://doi.org/10.1007/s00392-004-0130-0

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  • DOI: https://doi.org/10.1007/s00392-004-0130-0

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