Clinical case of a paradoxical embolism that caused an acute myocardial infarction after deep vein thrombosis
https://doi.org/10.21518/2307-1109-2020-2-161-168
Abstract
Paradoxical thromboembolism due to the presence of an patent foramen ovale (PFO) is a rather rare phenomenon, especially when an embolism results in acute myocardial infarction (MI). The presented clinical case of the paradoxical embolism is interesting for several reasons: firstly, the patient's primary disease was deep vein thrombosis (DVT) and pulmonary artery thromboembolism (PATE); secondly, apparently, it was due to PATE and the subsequent overload of the right side of the heart that thelatent embolism became apparent; thirdly, the paradoxical embolism was apparently caused by the fragments of alarge thrombus stuck in PFO, fourthly, the current clinical situation was ambiguous with respect to medical decisions, primarily concerning antithrombotic therapy.
About the Authors
Yu. V. Larchikova
Bauman City Clinical Hospital No. 29
Russian Federation
Russian Federation
Yuliya V. Larchikova - cardiologist of the emergency cardiology department, Bauman City Clinical Hospital No. 29.
2, Gospitalnaya Square, Moscow, 111020.
A. D. Ehrlikh
Bauman City Clinical Hospital No. 29
Russian Federation
Russian Federation
Aleksey D. Ehrlikh - Dr. of Sci. (Med.), head of the intensive cardiac care unit, Bauman City Clinical Hospital No. 29.
2, Gospitalnaya Square, Moscow, 111020.
I. N. Smetanina
Bauman City Clinical Hospital No. 29
Russian Federation
Russian Federation
Irina N. Smetanina - Cand. of Sci. (Med.), physician of the department of functional diagnostics, Bauman City Clinical Hospital No. 29.
2, Gospitalnaya Square, Moscow, 111020.
N. Yu. Zheltov
Bauman City Clinical Hospital No. 29
Russian Federation
Russian Federation
Nikita Yu. Zheltov - surgeon of the department of X-ray endovascular methods of diagnostics and treatment, Bauman City Clinical Hospital No. 29.
2, Gospitalnaya Square, Moscow, 111020.
References
1. Pristipino C., Sievert H., D'Ascenzo F., Louis Mas J., Meier B., Scacciatella P. et al. European position paper on the management of patients with patent foramen ovale. General approach andleft circulation thromboembolism. Eur Heart J. 2019;40(38):3182-3195. doi: 10.1093/eurheartj/ehy649.
2. Alias S., Lang I.M. Coagulation and the vessel wall in pulmonary embolism. Pulm Circ. 2013;3(4):728-738. doi: 10.1086/674768.
3. Guo S., Roberts I., Missri J. Paradoxical embolism, deep vein thrombosis, pulmonary embolism in a patient with patent foramen ovale: a case report. J Med Case Reports. 2007;1:104. doi: 10.1186/1752-1947-1-104.
4. Anyfantakis D., Karona P., Kastanaki P., Kourakos A., Kastanakis M. Multiorgan paradoxical embolism in an elderly female with a patent foramen ovale: a case report. Med Pharm Rep. 2019;92(1):83-86. doi: 10.15386/cjmed-1031.
5. Abusnina W., Megri M., Edris B., El-Hamdani M. Arterial embolism in a patient with pulmonary embolism and patent foramen ovale. Proc (Bayl Univ Med Cent). 2019;32(2):256-258. doi: 10.1080/08998280.2019.1576460.
6. Falcetta G., Scioti G., Barzaghi C., Bortolotti U. Pulmonary and paradoxical coronary embolism with a patent foramen ovale. Asian Cardiovasc Thorac Ann. 2018;26(5):413-415. doi: 10.1177/0218492318777394.
7. Ogren M., Bergqvist D., Eriksson H., Lindblad B., Sternby N.H. Prevalence and risk of pulmonary embolism in patients with intracardiac thrombosis: a population-based study of 23 796 consecutive autopsies. Eur Heart J. 2005;26(11):1108-1114. doi: 10.1093/eurheartj/ehi130.
8. Shah C.P., Thakur R.K., Ip J.H., Xie B., Guiraudon G.M. Management of mobile right atrial thrombi: a therapeutic dilemma. J Card Surg. 1996;11(6):428-431. doi: 10.1111/j.1540-8191.1996.tb00077.x.
9. Rose P.S., Punjabi N.M., Pearse D.B. Treatment of right heart thromboemboli. Chest. 2002;121(3):806-814. doi: 10.1378/chest.121.3.806.
10. Niku A., Shiota T., Siegel R.J., Rader F. Prevalence and Resolution of Left Atrial Thrombus in Patients With Nonvalvular Atrial Fibrillation and Flutter With Oral Anticoagulation. Am J Cardiol. 2019;123(1):63-68. doi: 10.1016/j.amjcard.2018.09.027.
11. Lip G.Y., Hammerstingl C., Marin F., Cappato R., Meng I.L., Kirsch B. et al. Left atrial thrombus resolution in atrial fibrillation or flutter: Results a prospective study with rivaroxaban (X-TRA) and a retrospective observational registry providing baseline data (CLOT-AF). Am Heart J. 2016;178:126-134. doi: 10.1016/j.ahj.2016.05.007.
12. Ezekowitz M.D., Pollack C.V. Jr., Halperin J.L., England R.D., VanPelt Nguyen S., Spahr J. et al. Apixaban compared to heparin/vitamin K antagonist in patients with atrial fibrillation scheduled for cardioversion: the EMANATE trial. Eur Heart J. 2018;39(32):2959-2971. doi: 10.1093/eurheartj/ehy148.
13. Konstantinides S.V., Meyer G., Becattini C., Bueno H., Geersing G.J., Harjola V.P. et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020;41(4):543-603. doi: 10.1093/eurheartj/ehz405.
14. Gibson C.M., Mehran R., Bode C., Halperin J., Verheugt F.W., Wildgoose P. et al. Prevention of Bleeding in Patients with Atrial Fibrillation Undergoing PCI. N Engl J Med. 2016;375(25):2423-2434. doi: 10.1056/NEJMoa1611594.
15. Cannon C.P., Bhatt D.L., Oldgren J., Lip G.Y.H., Ellis S.G., Kimura T. et al. Dual Antithrombotic Therapy with Dabigatran after PCI in Atrial Fibrillation. N Engl J Med. 2017;377(16):1513-1524. doi: 10.1056/NEJMoa1708454.
16. Lopes R.D., Heizer G., Aronson R., Vora A.N., Massaro T., Mehran R. et al. Antithrombotic Therapy after Acute Coronary Syndrome or PCI in Atrial Fibrillation. N Engl J Med. 2019;380(16):1509-1524. doi: 10.1056/NEJMoa1817083.
Review
For citations:
Larchikova Yu.V., Ehrlikh A.D., Smetanina I.N., Zheltov N.Yu. Clinical case of a paradoxical embolism that caused an acute myocardial infarction after deep vein thrombosis. Aterotromboz = Atherothrombosis. 2020;(2):161-168. (In Russ.) https://doi.org/10.21518/2307-1109-2020-2-161-168
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