Myocardial Infarction Due to Paradoxical Thromboembolism Originating From Distal Lower Extremity Deep Vein Thrombosis (LEDVT)

Abstract

Paradoxical embolism (PDE) originates in the venous system and ends up in the arterial circulation via cardiac or pulmonary shunts. Cases of PDE from venous thrombosis resulting in acute myocardial infarctions (MIs) are seldom reported in the literature. Diagnoses can often be missed if further workups are not pursued in patients without any underlying risk factors for coronary artery disease (CAD). Here, we report a case of a paradoxical embolus that crossed the patent foramen ovale (PFO), causing ST-elevation MI (STEMI) from an embolized venous thrombus originating in the left distal posterior tibial vein.

Keywords: echocardiogram; myocardial infarction; paradoxical emboli; patent foramen ovale; thrombus.

Figure 1. (a) A 16 mm, 80% de novo occlusion of LAD; (b) captured after drug-eluting stent placement with a brisk return of blood flow (TIMI grade 3).

LAD, left anterior descending; TIMI, thrombolysis in myocardial infarction

Figure 2. Transthoracic echocardiogram with agitated saline showed evidence of a PFO, and transesophageal echocardiogram with a bubble study confirmed the presence of a PFO measuring 2 to 3 mm.

PFO, patent foramen ovale

Figure 3. Bilateral lower extremity venous duplex ultrasound performed revealed occlusive thrombosis of the left distal posterior tibial vein.