Chen Zhongxiu, Li Chen, Li Yajiao, Tang Hong, Rao Li, Wang Mian
Department of Cardiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
Medicine (Baltimore). 2017 Dec;96(52):e9480. doi: 10.1097/MD.0000000000009480.
The differential diagnosis of acute chest pain is very important, and can sometimes be challenging. Related diseases share a number of risk factors, and occasionally, 1 condition causes another disease to develop.
We described a 59-year-old man who presented to emergency department complaining of chest pain.
He was suffered acute myocardial infarction (MI) and pulmonary embolism (PE) simultaneously.
Dual antiplatelet therapy, statin, and low molecular weight heparin were administrated during his stay. The searches for cancers, autoimmune diseases, and hematologic diseases were unremarkable, ruling out a hypercoagulable state. Subsequent ultrasound scan revealed a thrombus in a vein of the lower left extremity. Thus, paradoxical embolism was highly suspected.
Paradoxical embolism is a rare cause of acute MI, which may have occurred in our patient. This was evidenced by a previously unrecognized patent foramen ovale (PFO) with a right-to-left atrial shunt detected using contrast transesophageal echocardiography.
Acute MI complicated with PE is not common in the clinical setting. The fatal condition is difficult to diagnose because of the similar symptoms and confusing causes. Paradoxical embolism can cause this phenomenon, and physicians should be highly vigilant in the search for a PFO in cases of paradoxical embolism.
急性胸痛的鉴别诊断非常重要，有时也具有挑战性。相关疾病有许多共同的危险因素，而且偶尔一种疾病会导致另一种疾病的发生。
我们描述了一名59岁男性，他因胸痛到急诊科就诊。
他同时患有急性心肌梗死（MI）和肺栓塞（PE）。
住院期间给予双联抗血小板治疗、他汀类药物和低分子肝素。对癌症、自身免疫性疾病和血液系统疾病的检查未发现异常，排除了高凝状态。随后的超声扫描显示左下肢静脉有血栓。因此，高度怀疑为反常栓塞。
反常栓塞是急性心肌梗死的罕见原因，可能在我们的患者中发生。经食管对比超声心动图检测到先前未被识别的卵圆孔未闭（PFO）伴右向左心房分流，证明了这一点。
急性心肌梗死合并肺栓塞在临床中并不常见。由于症状相似且病因复杂，这种致命情况很难诊断。反常栓塞可导致这种现象，医生在反常栓塞病例中寻找卵圆孔未闭时应高度警惕。
