Croft A P, Khan J N, Chittari M V, Varma C
Centre for Translational Inflammation Research, University of Birmingham Research Laboratories, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK.
J R Coll Physicians Edinb. 2012;42(3):218-20. doi: 10.4997/JRCPE.2012.306.
Paradoxical coronary artery embolism is a rare but under-diagnosed cause of acute myocardial infarction (AMI) and requires a high level of clinical suspicion to make an early diagnosis. We describe the case of a young woman who presented with a severe cough and chest pain who was subsequently found to have a paradoxical embolus in the right coronary artery. Echocardiography showed a patent foramen ovale (PFO) and an atrial septal aneurysm (ASA). The patient was found to be a heterozygous carrier of the factor V Leiden mutation that increases the risk for venous-thromboembolism. The association between a PFO and an ASA is a risk factor for systemic embolisation. This is the first reported case of paradoxical coronary artery embolus causing AMI in a non-pregnant patient with factor Leiden thrombophilia. Identification of this clinical phenotype is vital as the risk of future embolic events can be reduced by anticoagulation and closure of anatomical cardiac defects.
反常冠状动脉栓塞是急性心肌梗死（AMI）的一种罕见但诊断不足的病因，需要高度的临床怀疑才能早期诊断。我们描述了一名年轻女性的病例，她出现严重咳嗽和胸痛，随后被发现右冠状动脉有反常栓子。超声心动图显示卵圆孔未闭（PFO）和房间隔瘤（ASA）。该患者被发现是因子V莱顿突变的杂合子携带者，该突变增加了静脉血栓栓塞的风险。PFO和ASA之间的关联是全身栓塞的一个危险因素。这是首例报道的在非妊娠因子莱顿血栓形成倾向患者中由反常冠状动脉栓子导致AMI的病例。识别这种临床表型至关重要，因为抗凝和闭合心脏解剖缺陷可降低未来栓塞事件的风险。
