{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T22:18:28Z","timestamp":1785449908853,"version":"3.56.0"},"reference-count":3,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2018,12,1]],"date-time":"2018-12-01T00:00:00Z","timestamp":1543622400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2018,12,1]],"date-time":"2018-12-01T00:00:00Z","timestamp":1543622400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Echo Res Pract"],"published-print":{"date-parts":[[2018,12]]},"abstract":"<jats:title>Summary<\/jats:title>\n               <jats:p>Non-atherosclerotic myocardial infarction (MI) is an important but often misdiagnosed cause of acute MI. Furthermore, non-atherosclerotic MI with concomitant acute stroke and pulmonary embolism due to in-transit thrombus across a patent foramen ovale (PFO) is a rare but potentially fatal combination (1, 2, 3). Early detection of this clinical entity can facilitate delivery of targeted therapies and avoid poor outcome (1, 2). Here, we describe a 68-year-old female with hypertension, tobacco abuse and chronic obstructive pulmonary disease presenting with facial droop, right arm weakness and aphasia. Head computed tomography (CT) without contrast was unremarkable. ECG showed an acute inferolateral ST-elevation MI (Fig. 1, Panel A). As patient presented with both an acute neurological deficit and MI, clinical suspicion of non-atherosclerotic MI was raised and the patient underwent concurrent emergency coronary angiography (CAG) and transesophageal echocardiogram (TEE). TEE revealed highly mobile masses in the left and right atrium (Fig. 1, Panel B and Video 1). The large mass (thrombus or cast of a deep venous thrombus) was caught in a PFO (Fig. 1, Panel C, D, E and Videos 2, 3). A second smaller mass\/thrombus was seen on the Eustachian valve near the right atrial\/inferior vena cava junction (Fig. 1, Panel F and Video 4). CAG confirmed a 100% occluded distal right posterolateral artery suggestive of an embolic phenomenon. The patient underwent successful thrombectomy, retrieving a large thrombus burden (Fig. 1, Panel G and Videos 5, 6, 7). CT angiography showed occluded internal carotid artery (Fig. 1, Panel H). Pathology from thrombectomy confirmed fibrin-rich thrombus. The patient had bilateral lower extremity deep vein thrombosis and bilateral diffuse pulmonary embolisms.<\/jats:p>","DOI":"10.1530\/erp-18-0044","type":"journal-article","created":{"date-parts":[[2018,8,11]],"date-time":"2018-08-11T18:15:10Z","timestamp":1534011310000},"page":"I9-I10","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Concomitant acute stroke, pulmonary and myocardial infarction due to in-transient thrombus across a patent foramen ovale"],"prefix":"10.1186","volume":"5","author":[{"given":"Sergio","family":"Barros-Gomes","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdallah El","family":"Sabbagh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mackram F.","family":"Eleid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunil V.","family":"Mankad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2018,12,1]]},"reference":[{"key":"504009_CR1","doi-asserted-by":"publisher","first-page":"403","DOI":"10.1016\/j.jacc.2014.04.063","volume":"64","author":"S Windecker","year":"2014","unstructured":"Windecker S, Stortecky S & Meier B. Paradoxical embolism. Journal of the American College of Cardiology 2014 64 403\u2013415. (https:\/\/doi.org\/10.1016\/j.jacc.2014.04.063)","journal-title":"Journal of the American College of Cardiology"},{"key":"504009_CR2","doi-asserted-by":"publisher","first-page":"155","DOI":"10.7326\/0003-4819-88-2-155","volume":"88","author":"KR Prizel","year":"1978","unstructured":"Prizel KR, Hutchins GM & Bulkley BH. Coronary artery embolism and myocardial infarction. Annals of Internal Medicine 1978 88 155\u2013161.","journal-title":"Annals of Internal Medicine"},{"key":"504009_CR3","doi-asserted-by":"publisher","first-page":"984.e5","DOI":"10.1016\/j.ajem.2014.12.025","volume":"33","author":"M Hay\u0131ro\u011flu","year":"2015","unstructured":"Hay\u0131ro\u011flu M\u0130, Bozbeyo\u011flu E, Aky\u00fcz \u015e, Y\u0131ld\u0131r\u0131mt\u00fcrk \u00d6, Bozbay M, Bakhshaliyev N, Renda E, G\u00f6k G, Eren M, Pehlivano\u011flu S. Acute myocardial infarction with concomitant pulmonary embolism as a result of patent foramen ovale. American Journal of Emergency Medicine 2015 33 984.e5\u2013984.e7. (https:\/\/doi.org\/10.1016\/j.ajem.2014.12.025)","journal-title":"American Journal of Emergency Medicine"}],"container-title":["Echo Research &amp; Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1530\/ERP-18-0044\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1530\/ERP-18-0044.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1530\/ERP-18-0044","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1530\/ERP-18-0044.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,4,22]],"date-time":"2022-04-22T02:07:09Z","timestamp":1650593229000},"score":1,"resource":{"primary":{"URL":"https:\/\/echo.biomedcentral.com\/articles\/10.1530\/ERP-18-0044"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,12]]},"references-count":3,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2018,12]]}},"alternative-id":["504009"],"URL":"https:\/\/doi.org\/10.1530\/erp-18-0044","relation":{},"ISSN":["2055-0464"],"issn-type":[{"value":"2055-0464","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,12]]},"assertion":[{"value":"31 July 2018","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 August 2018","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 December 2018","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}}]}}