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• W4387249541 abstract "SESSION TITLE: Cardiovascular Disease Case Report Posters 12 SESSION TYPE: Case Report Posters PRESENTED ON: 10/10/2023 09:40 am - 10:25 am INTRODUCTION: ST Segment Elevation Myocardial Infarction (STEMI) and acute Pulmonary Embolism (PE) are both life-threatening diseases that initially present with chest pain. Simultaneous occurrence of the acute myocardial infarction like STEMI and PE is a very infrequent event in the population. Clinicians should be watchful about the possibility of PE in the differential diagnosis of acute chest pain in young patients suspected of Myocardial Infarction (MI). An acute PE can further increase the right atrial pressure which can reopen the closed PFO and facilitates the Paradoxical Embolus to travel through it into the systemic circulation CASE PRESENTATION: A 48-year-old female athlete with prior history of chest pain was presented with cardiac arrest. A 12-lead electrocardiogram (ECG) showed superior ST-segment elevation. She was transferred to cardiac catheter laboratory where echocardiography done and coronary angiography performed via the right radial artery and cardio angiogram obtained, which showed complete occlusion of the RCA. No atherosclerotic changes observed. After stabilization, she was transferred to radiology department for computed tomography pulmonary angiogram (CTPA), which confirmed acute pulmonary embolism. Subsequent Transthoracic echocardiogram with bubble-agitated saline revealed a patent foramen ovale (PFO). She underwent mechanical thrombectomy, balloon angioplasty, heparin dosing and post improvement in her clinical status, she was discharged. 6 months later, as a follow up, successful PFO closure for secondary prevention was done. After 12 months, she was examined at outpatient clinic with marked improvement DISCUSSION: In the present case, the patient had no risk factors for STEMI as there was no sign of atherosclerotic changes. So, the cause of STEMI might be due to paradoxical embolism, through the existing PFO. The combination of paradoxical embolism with concomitant PE is also extremely rare. A significantly large PE is sometimes identified as a favourable factor for the embolism to travel across a PFO. An acute PE results in elevated right atrial pressure and systemic hypotension, promoting reversed (right-to-left) blood flow across the PFO, thus increasing the risk of concomitant PDE and stroke .Therefore, concomitant STEMI and PE can be indicative of a PDE.However, the clinical manifestations in case of STEMI and acute PE have many similarities including acute dyspnea, chest pain, syncope and palpitations, which poses a challenge in joint diagnosis (Zelfani S, Manai H). The symptoms and ECG changes like ST segment elevation in both cases often resembles to one pathology i.e. acute MI. For this reason, additional information regarding a past history of deep vein thrombosis (DVT) or PE, or accompanying symptoms (difficulty in breathing, cough or respiratory failure),etc will be helpful for clinicians to differentiate between STEMI and PE CONCLUSIONS: Concomitant STEMI with the etiology of PDE via PFO , and PE is a lethal combination which needs early treatment. Early involvement of a multidisciplinary team to define the treatment plan according to the patient's clinical presentation is vital to produce the best outcomes.(. Patients need to be educated on the prevention of blood clots by avoiding a sedentary lifestyle, wearing compression stockings if they have varicose veins, and taking the oral anticoagulants as prescribed. REFERENCE #1: Kujime S, Hara H, Enomoto Y, Yoshikawa H, Itaya H, Noro M, Suzuki M, Nakamura M, Sugi K. A case of paradoxical embolic ST-segment elevation myocardial infarction triggered by sleep apnea. Intern Med. 2012;51(14):1851-5. doi: 10.2169/internalmedicine.51.7069. Epub 2012 Jul 15. PMID: 22821099. DISCLOSURES: No relevant relationships by Veera Pavan Kotaru No relevant relationships by Sai Rohit Mekala" @default.
• W4387249541 created "2023-10-03" @default.
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• W4387249541 date "2023-10-01" @default.
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• W4387249541 title "CONCOMITANT MYOCARDIAL INFARCTION, PULMONARY EMBOLISM, AND ANOXIC ENCEPHALOPATHY IN A PATIENT WITH PARADOXICAL EMBOLISM DUE TO PATENT FORAMEN OVALE" @default.
• W4387249541 doi "https://doi.org/10.1016/j.chest.2023.07.538" @default.
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