Cardiac magnetic resonance imaging unmasks presumed embolic myocardial infarction due to patent foramen ovale case report

Kate Liang, Matthew Williams, Chiara Bucciarelli-Ducci*

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

2 Citations (Scopus)
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Occurrence of paradoxical coronary embolism is reported in up to 10–15% of all myocardial infarctions but embolic infarctions presumed to be as a result of a patent foramen ovale (PFO) are rare. Although rare, it is important to identify these patients as they need appropriate investigations to confirm their diagnosis and guide further treatment.

Case summary
We present the case of a gentleman with troponin positive chest pain with non-obstructed coronaries on invasive coronary angiogram. Subsequent cardiac magnetic resonance imaging (MRI) demonstrated multi-focal myocardial infarctions in several coronary artery territories. Further investigations including echocardiogram were performed in order to identify a cause and source of the embolic infarctions and led to the diagnosis of patent foramen ovale. The patient was treated as myocardial infarction with non-obstructed coronary arteries most likely due to embolic phenomena in the presence of a PFO.

Multiple focal infarctions in multiple coronary artery territories should raise the suspicion of an intra-cardiac shunt. Multi-modality imaging with cardiac MRI and echocardiogram is important in correctly identifying any source of emboli and the diagnosis of any intra-cardiac shunt. Whilst PFO closure is a possible treatment for patients, considerations regarding risk stratification and local provisions needs to be taken into account. Patients should be referred to the appropriate subspecialist to ensure suitable long-term follow-up.
Original languageEnglish
Article numberytac029
Number of pages6
JournalEuropean Heart Journal - Case Reports
Issue number2
Publication statusPublished - 1 Feb 2022

Bibliographical note

Publisher Copyright:
© 2022 The Author(s). Published by Oxford University Press on behalf of the European Society of Cardiology.


  • Cardiac MRI
  • Multi-modality imaging
  • Embolic myocardial infarction
  • Patent foramen ovale
  • Case report


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