Article Versions
Export Article
Case Report
Open Access Peer-reviewed

STEMI and CVA in Hypercoagulable State with Ostium Secundum Defect

Mohammed Al-Sadawi1, Bader Madoukh2, Ayman Battisha3, Shakil Shaikh1, Jonathan Marmur1, Fadi Yacoub1, Samy I. McFarlane4,

1State University of New York: Downstate Medical Center

2Overland Park Regional Medical Center-HCA Midwest Health

3UMMS-Baystate Medical Center

4SUNY-Downstate, Brooklyn, New York USA

American Journal of Medical Case Reports. 2019, 7(12), 320-324. DOI: 10.12691/ajmcr-7-12-5
Received August 10, 2019; Revised September 14, 2019; Accepted September 22, 2019

Abstract

Atrial septal defect (ASD) is a risk factor for multiple vascular thrombotic events, which can occur either sequentially or simultaneously. In this report we present a case of ST-elevation myocardial infarction (STEMI) and cerebrovascular accident (CVA). The severity of adverse cardiovascular or cerebrovascular events can be increased by the presence of specific type of ASD, such as a patent foramen ovale (PFO) or osteum secundum defect. This case report discusses a unique presentation of a 48-year old male on warfarin therapy for a history of cerebral venous thrombosis (CVT) who subsequently presented with simultaneous STEMI with CVA, and who was incidentally found to have an ostium secundum defect on echocardiography. He was emergently taken for cardiac catheterization, which revealed significant proximal LAD occlusion. There has been a long standing debate within the international scientific communities regarding the therapeutic benefit of PFO closure for long-term secondary prevention of recurrence CVA. We discuss the different points of view regarding PFO closure for secondary prevention of CVA with a review of the literature on this rather controversial topic.

Keywords:

hypercoagulability, atrial septal defect, myocardial infarction, cerebrovascular accident
[1]  Köhrmann, M., Schellinger, P. D., Tsivgoulis, G., & Steiner, T. (2019). Patent Foramen Ovale: Story Closed? J Stroke, 21(1), 23-30.View Article  PubMed  PubMed 
 
[2]  Aparci, M., Uz, O., Atalay, M., & Kardesoglu, E. (2016). Paradoxical coronary artery embolism due to patent foramen ovale. Int J Cardiol, 209, 164.View Article  PubMed 
 
[3]  Trabattoni, D., Zaro, T., & Garducci, S. (2012). A myocardial infarction may disclose patent foramen ovale. J Cardiol Cases, 5(2), e80-e82.View Article  PubMed  PubMed 
 
[4]  Favilla, C. G., & Messé, S. R. (2018). New Data Support Patent Foramen Ovale Closure After Stroke. Stroke, 49(1), 262-264.View Article  PubMed 
 
[5]  Carroll, J. D., Saver, J. L., Thaler, D. E., Smalling, R. W., Berry, S., MacDonald, L. A. Investigators, R. (2013). Closure of patent foramen ovale versus medical therapy after cryptogenic stroke. N Engl J Med, 368(12), 1092-1100.View Article  PubMed 
 
[6]  Meier, B., Kalesan, B., Mattle, H. P., Khattab, A. A., Hildick-Smith, D., Dudek, D. Investigators, P. T. (2013). Percutaneous closure of patent foramen ovale in cryptogenic embolism. N Engl J Med, 368(12), 1083-1091.View Article  PubMed 
 
[7]  Mas, J. L., Derumeaux, G., Guillon, B., Massardier, E., Hosseini, H., Mechtouff, L. Investigators, C. (2017). Patent Foramen Ovale Closure or Anticoagulation vs. Antiplatelets after Stroke. N Engl J Med, 377(11), 1011-1021.View Article  PubMed 
 
[8]  Furlan, A. J., Reisman, M., Massaro, J., Mauri, L., Adams, H., Albers, G. W. Investigators, C. I. (2012). Closure or medical therapy for cryptogenic stroke with patent foramen ovale. N Engl J Med, 366(11), 991-999.View Article  PubMed 
 
[9]  Saver, J. L., Carroll, J. D., Thaler, D. E., Smalling, R. W., MacDonald, L. A., Marks, D. S. Investigators, R. (2017). Long-Term Outcomes of Patent Foramen Ovale Closure or Medical Therapy after Stroke. N Engl J Med, 377(11), 1022-1032.View Article  PubMed 
 
[10]  Anantha-Narayanan, M., Anugula, D., & Das, G. (2018). Patent foramen ovale closure reduces recurrent stroke risk in cryptogenic stroke: A systematic review and meta-analysis of randomized controlled trials. World J Cardiol, 10(6), 41-48.View Article  PubMed  PubMed 
 
[11]  Collado, F. M. S., Poulin, M. F., Murphy, J. J., Jneid, H., & Kavinsky, C. J. (2018). Patent Foramen Ovale Closure for Stroke Prevention and Other Disorders. J Am Heart Assoc, 7(12).View Article  PubMed  PubMed 
 
[12]  Ali, R. A., Asadollah, M., & Hossien, R. A. (2010). The Role of Unknown Risk Factors in Myocardial Infarction. Cardiol Res, 1(1), 15-19.
 
[13]  Hakim, F. A., Kransdorf, E. P., Abudiab, M. M., & Sweeney, J. P. (2014). Paradoxical coronary artery embolism - a rare cause of myocardial infarction. Heart Views, 15(4), 124-126.View Article  PubMed  PubMed 
 
[14]  Kottoor, S. J., & Arora, R. R. (2018). Cryptogenic Stroke: To Close a Patent Foramen Ovale or Not to Close? J Cent Nerv Syst Dis, 10, 1179573518819476.View Article  PubMed  PubMed 
 
[15]  Sondergaard, L., Kasner, S. E., Rhodes, J. F., Andersen, G., Iversen, H. K., Nielsen-Kudsk, J. E. Investigators, G. R. C. S. (2017). Patent Foramen Ovale Closure or Antiplatelet Therapy for Cryptogenic Stroke. N Engl J Med, 377(11), 1033-1042.View Article  PubMed