Paroxysmal atrial fibrillation presenting as anterior wall STEMI in an elderly woman.
Muhammad Asim ShabbirMuhammad Hamza Saad ShaukatLance SullenbergerMikhail TorosoffPublished in: BMJ case reports (2019)
A 77-year-old woman without traditional risk factors for coronary artery disease (CAD) underwent coronary CT-angiography for evaluation of palpitations after negative Holter monitoring and non-diagnostic ECG exercise stress test. Coronary artery calcium score was reported zero; 1 day later, she was admitted with anterior-wall ST elevation myocardial infarction. Acute left anterior descending artery thrombus was treated with mechanical thrombectomy and Percutaneous Coronary Intervention (PCI). Interestingly, the coronary arteries were angiographically normal. During hospitalisation, paroxysmal atrial fibrillation was noted followed by initiation of anticoagulation. Echocardiogram did not show thrombus or atrial shunt. Cardioversion with Sotalol was successful. Myocardial infraction was most likely cardioembolic secondary to paroxysmal atrial fibrillation-consistent with longstanding history of palpitations. Accounting for 3% of acute coronary syndromes, coronary embolism is treated with therapeutic anticoagulation for at least 3 months irrespective of cause and carries a higher risk of adverse cardiovascular events.
Keyphrases
- atrial fibrillation
- percutaneous coronary intervention
- coronary artery disease
- st elevation myocardial infarction
- cardiovascular events
- st segment elevation myocardial infarction
- coronary artery
- catheter ablation
- acute myocardial infarction
- antiplatelet therapy
- coronary artery bypass grafting
- left atrial
- oral anticoagulants
- left atrial appendage
- direct oral anticoagulants
- pulmonary artery
- acute coronary syndrome
- heart failure
- coronary artery bypass
- liver failure
- heart rate variability
- left ventricular
- cardiovascular disease
- aortic stenosis
- type diabetes
- emergency department
- blood pressure
- drug induced
- physical activity
- hepatitis b virus
- respiratory failure
- blood flow
- intensive care unit
- case report