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Document Details : Title: Paradoxical coronary embolism, a rare cause of acute myocardial infarction on positive pressure ventilation Author(s): J. Bennett , L. Ong , C. Hanratty Journal: Acta Cardiologica Volume: 67 Issue: 4 Date: 2012 Pages: 477-479 DOI: 10.2143/AC.67.4.2170693 Abstract : A 65-year-old man developed respiratory failure and was admitted to the Intensive Care Unit for positive pressure ventilation and antibiotic and antifungal therapy. There was a sudden deterioration with chest pain, worsening hypoxia and hypotension. Serial electrocardiograms showed new onset right bundle-branch block with developing anterior ST-segment elevation. An urgent coronary angiogram revealed acute occlusion of the left anterior descending artery with a single large distinct thrombus, which was successfully removed with an aspiration catheter. A presumptive diagnosis of paradoxical coronary embolus was made. A short review is provided of this relatively rare clinical entity which has the potential to present in intensive care patients who have an underlying intra-cardiac defect and require positive pressure ventilation. This case emphasises the importance of being aware of less common causes of acute clinical deterioration and electrocardiographic changes in the ventilated patient. |
