Inferolateral ST-Segment Elevation Myocardial Infarction Secondary to Suspected Coronary Embolism in a Patient with Paroxysmal Atrial Fibrillation: A Case Report.
Sai Tharun Reddy Gopannagari, Kesava Manikanta Achuta, Ishan Kirti et al.
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Case in brief
A 76-year-old man with paroxysmal atrial fibrillation presented with acute substernal chest pain and inferolateral ST-segment elevation myocardial infarction. Angiography showed complete thrombotic occlusion of the distal right posterolateral ventricular branch, with otherwise nonobstructive coronary disease. Given the abrupt distal occlusion, minimal atherosclerosis, atrial fibrillation, and fulfillment of the Shibata diagnostic criteria, coronary embolism was considered the most likely mechanism. Long-term anticoagulation was continued, and he was asymptomatic at 1-month follow-up.
What made this case unusual
The infarction was attributed to suspected coronary embolism despite presentation as STEMI; angiography showed an abrupt distal branch occlusion with minimal underlying coronary atherosclerosis in a patient with paroxysmal atrial fibrillation.
Diagnostic / clinical pearl
In a patient with atrial fibrillation and STEMI, an abrupt distal coronary occlusion with little underlying atherosclerosis should prompt consideration of coronary embolism; the Shibata criteria supported that assessment in this case.