Journal of Coronary Heart Diseases

Acute Myocardial Infarction in a Young Female with Elevated Lipoprotein (a) and a Secundum Atrial Septal Defect

Abstract

Matthew Schmidt, Timothy E Paterick

Paradoxical coronary artery embolism and spontaneous coronary artery dissection are rare causes of acute myocardial infarction in young females. These unusual etiologies for myocardial infarction should be considered in young female patients presenting with chest pain and at a low risk profile, by Bayesian analysis, for coronary atherosclerosis.

We present a case of a 21-year - old female of a paradoxical embolism causing ST elevation myocardial infarction in a patient with markedly elevated Lipoprotein (a) levels and an atrial septal defect. Chest pain, abnormal ECG, and elevated troponins led to coronary angiography demonstrating a clot in the obtuse marginal branch of the circumflex coronary artery. Echocardiography revealed an unknown atrial septal defect with bidirectional shunting. The question we address is whether closure of the atrial septal defect is appropriate to prevent a recurrence of a paradoxical embolism.