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Acute inferior ST-segment elevation myocardial infarction and previous cryptogenic stroke caused by a paradoxical embolism with a concomitant pulmonary embolism

Hong-Yu Zhang,Yan Zhang,Yanjun Cao,Lianlian Mei,Xia Zhang,Zhiguo Wu,Baohua Qiu,Shujing Wang

Published 2017 in Journal of Geriatric Cardiology

ABSTRACT

A 61-year-old woman was hospitalized for a chief complaint of sudden chest tightness with sweating for two hours. The chest tightness and sweating occurred suddenly and without remission after a morning stool. Electrocardiography showed a complete atrioventricular (AV) block and arc-like elevation of the ST-segment in leads II, III, AVF, V7–V9, and V3R–V5R, at about 0.05–0.15 mV. After being administered 1 mg of atropine in the emergency room (ER), the patient was admitted to the cardiology department. The patient had been found in a cyanotic state two years previously, but did not receive any treatment; she was diagnosed with a transient ischemic attack (TIA) 1.5 years previously because of limb dyskinesia accompanied by slurred speech. Finally, she had been newly diagnosed with pulmonary hypertension one year previously because of exercise limitations (she developed chest tightness after walking on a flat surface for 250 m, which was alleviated after resting).  Results of her physical examination revealed the following: blood pressure, 93/65 mmHg (1 mmHg = 0.133 kPa); lip cyanosis; jugular vein engorgement; no evidence of rhonchi and moist rales; bilateral expansion of the heart; heart rate, 78 beats/min; arrhythmia; S1 low blunt; P2 hyperthyroidism and split; and no pathological murmurs. We performed percutaneous coronary intervention (PCI). Coronary angiography showed that the right coronary artery was completely occluded before the second turn, where a thrombus was seen (Figure 1A). We injected 0.5 mg tirofiban twice by the guide catheter, and a medium-sized thrombus was withdrawn by thrombus aspiration (Figure 1B). The invasive blood pressure decreased during aspiration, and no blood returning was found to be under negative

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