Paradoxical embolism causing myocardial infarction
In this case report, published in the Journal of Medical Case Reports, the authors present a case of a likely paradoxical embolism in a young patient with no significant risk factor for coronary artery disease that initially presented with shortness of breath and bilateral calf pain that was found to have a deep vein thrombosis.

There was a development of a pulmonary embolism that we believed due to right ventricular strain resulted in an embolus crossing into the arterial system via an intracardiac shunt causing a myocardial infarction via a distal occlusion of the right coronary artery.

Patient was treated with full dose anticoagulation and a patent foramen ovale (PFO) closure was recommended.

The authors hypothesized that due to right ventricular strain, there was increased right-sided pressure, and the change in pressure gradient in the right into the left atrium caused the sudden reversal of blood flow direction, which allowed the emboli to travel into the left circulation. Eventually, the embolus lodged into distal RCA causing myocardial infarction.

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