Coronary Embolism and Myocardial Infarction: A Scoping Study

Pramod Theetha Kariyanna^{1, 2}, Benjamin Ramalanjaona^{1, 2}, Mohammed Al-Sadawi^{1, 2}, Apoorva Jayarangaiah³, Sudhanva Hegde^{1, 2} and Isabel M. McFarlane^{1, 2,}

¹Department of Internal Medicine, Division of Cardiology, SUNY, Downstate Health Sciences University, Brooklyn, N.Y., U.S.A-11203

²Division of Cardiovascular Disease, Department of Internal Medicine, State University of New York, Downstate Health Sciences University, NYC Health + Hospitals/Kings County, Brooklyn, N.Y., U.S.

³Department of Internal Medicine, NYC Health + Hospitals/Jacobi Medical Center, Bronx, N.Y., U.S.A-10461

Cite this paper

Pramod Theetha Kariyanna, Benjamin Ramalanjaona, Mohammed Al-Sadawi, Apoorva Jayarangaiah, Sudhanva Hegde and Isabel M. McFarlane. Coronary Embolism and Myocardial Infarction: A Scoping Study. American Journal of Medical Case Reports. 2020; 8(2):31-43. doi: 10.12691/AJMCR-8-2-1

Abstract

Coronary embolism is a cause of acute myocardial infarction (AMI)in which obstructive foci enter the coronary circulation, block normal blood flow and precipitate ischemia. Precise studies focusing on patient population affected, pathophysiological mechanisms, and treatment strategies are scanty, in spite of a reported prevalence estimated at 2.9%. As the understanding of myocardial infarction without evidence of coronary artery disease continues to grow, an in-depth review of this previously seldomly reported subtype of coronary ischemia was in order. Patients suffering coronary embolism are 15 to 20 years younger than traditional AMI patients with a slight predominance towards male sex, which resembles the gender data of the populations affected by non-traditional myocardial infarction in published reports. While the expected prevalence rate of cardiovascular disease risk factors such as hypertension and hyperlipidemia are present, this population also has a relatively high prevalence of atrial fibrillation and valve pathology, especially endocarditis. Initial presentation is indistinguishable from other causes of myocardial infarction however fever is commonly present, when endocarditis with valvular involvement is the primary cause of the coronary embolism. Mechanical thrombectomy is the mainstay of treatment, followed by percutaneous coronary intervention. Mortality is the highest in patients who do not receive targeted treatment for the coronary embolism, particularly if only antimicrobial agents or anticoagulation without thrombolytic agents are employed. The unique features of coronary embolism highlighted in this historical study justify further examination in contemporary patient populations.

Keywords

coronary embolism, acute myocardial infarction, non-traditional myocardial infarction, paradoxical coronary embolism, infectious endocarditis, valvular vegetations, atrial fibrillation, cardiovascular risk factors, prosthetic heart valve, thrombolytic therapy, management of coronary embolism

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

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