Shah Newton Ashish, Shah Sangam, Rijal Ashes, Chaudhary Anand, Chand Swati, Pandey Shailendra, Rawal Laba, Parajuli Suraj, Khanal Rajaram, Poudel Chandra Mani
Tribhuvan University, Institute of Medicine, Maharajgunj, 44600, Nepal.
Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal.
Ann Med Surg (Lond). 2022 Sep 8;82:104602. doi: 10.1016/j.amsu.2022.104602. eCollection 2022 Oct.
Coronary embolism (CE) is a rare cause of acute ST-elevation myocardial infarction (STEMI). Atrial fibrillation (AF), left ventricular thrombus, septic emboli from infective endocarditis, myxoma, and paradoxical embolism can induce emboli in coronary arteries.
Here we present a case of anterior wall STEMI secondary to paroxysmal AF in a 60-years-old female with a previous history of right-sided ischemic stroke.
The major criteria for diagnosis of coronary embolism include (1) non-atherosclerotic wall of coronary vessels under angiography; (2) concomitant involvement of multiple sites; (3) histological proof of venous thrombus; (4) imaging by echocardiography/CT/MRI showing intra-cardiac thrombus. The minor criteria include (1) <25% stenosis of other vessels supplying to infarct-free myocardium; (2) atrial fibrillation history; (3) risk factors like (prosthetic valve, bacterial endocarditis, patent foramen ovale, atrial septal defect, dilated cardiomyopathy).
Our case highlights the importance of cardiac embolus as a diagnosis in a patient with a history of stroke secondary to atrial fibrillation as a cause of acute STEMI and its management.
冠状动脉栓塞（CE）是急性ST段抬高型心肌梗死（STEMI）的罕见病因。心房颤动（AF）、左心室血栓、感染性心内膜炎的脓毒性栓子、黏液瘤和反常栓塞均可导致冠状动脉内形成栓子。
在此，我们报告一例60岁女性阵发性AF继发前壁STEMI的病例，该患者既往有右侧缺血性卒中病史。
冠状动脉栓塞的主要诊断标准包括：（1）血管造影显示冠状动脉血管壁无动脉粥样硬化；（2）多个部位同时受累；（3）静脉血栓的组织学证据；（4）超声心动图/CT/MRI成像显示心内血栓。次要标准包括：（1）供应无梗死心肌的其他血管狭窄<25%；（2）有房颤病史；（3）存在（人工瓣膜、细菌性心内膜炎、卵圆孔未闭、房间隔缺损、扩张型心肌病等）危险因素。
我们的病例强调了心脏栓子作为房颤继发卒中病史患者急性STEMI病因诊断及其管理的重要性。
