Paroxysmal atrial fibrillation presenting as anterior wall STEMI in an elderly woman

• Published in: BMJ case reports Vol. 12; no. 9; p. e231996
• Main Authors: Shabbir, Muhammad Asim, Saad Shaukat, Muhammad Hamza, Sullenberger, Lance, Torosoff, Mikhail
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.09.2019; BMJ Publishing Group
• Series: Case report
• Subjects: Acute coronary syndromes; Aged; Aspirin; Atrial Fibrillation - complications; Atrial Fibrillation - therapy; Blood clots; Cardiac arrhythmia; Cardiology; Cardiovascular disease; Case reports; Coronary Angiography; Coronary vessels; Coronary Vessels - diagnostic imaging; Dyspnea; Electric Countershock; Electrocardiography; Embolism - etiology; Embolisms; Endocarditis; Female; Health risk assessment; Heart attacks; Humans; Intervention; Medical imaging; Medical prognosis; Older people; Patients; Percutaneous Coronary Intervention; Sinuses; ST Elevation Myocardial Infarction - etiology; ST Elevation Myocardial Infarction - surgery; Systematic review; Thrombosis; Ultrasonic imaging; Unusual Presentation of More Common Disease/Injury; Womens health; arrhythmias; interventional cardiology; cardiovascular medicine
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2019-231996

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.