{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T20:25:08Z","timestamp":1787775908432,"version":"build-2784847793"},"reference-count":10,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T00:00:00Z","timestamp":1743465600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:p>We present a case of a 48-year-old man with an atypical type 2 myocardial infarction (MI)\/myocardial infarction with nonobstructive coronary arteries, caused by a coronary embolism originating from the inferior vena cava and passing through a patent foramen ovale (PFO). The patient presented to the emergency department with oppressive retrosternal chest pain. His medical history included papillary renal cell carcinoma and seminoma with recent abdominal lymph node recurrence. The electrocardiogram indicated an inferolateral ST-segment elevation (STE), prompting emergency coronary angiography, that revealed distal occlusion of the circumflex artery and the obtuse marginal branch, suggesting an embolic etiology. Stent placement was deferred, and the management approach involved thromboaspiration and unfractionated heparin infusion. Abdominal imaging identified a thrombotic formation in the inferior vena cava and a transesophageal echocardiogram revealed a PFO with a right-to-left shunt, supporting the diagnosis of a paradoxical embolism. Follow-up coronary angiography showed vessel patency, and the patient was then treated with low-molecular-weight heparin. This case underscores the importance of considering alternative etiologies for STE myocardial infarction beyond acute plaque rupture, highlighting the need for individualized management strategies, particularly in patients with complex medical histories, and given the lack of standardized treatment guidelines for coronary embolism.<\/jats:p>","DOI":"10.4103\/jcecho.jcecho_75_24","type":"journal-article","created":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T08:00:09Z","timestamp":1753948809000},"page":"165-168","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Paradoxical Coronary Embolism Leading to ST-segment Elevation Myocardial Infarction in a Patient with Caval Thrombosis"],"prefix":"10.4103","volume":"35","author":[{"given":"Davide","family":"Restelli","sequence":"first","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riccardo","family":"Molinari","sequence":"additional","affiliation":[{"name":"Department of Medical and Cardiological Care, University of Campania \u201cLuigi Vanvitelli\u201d, Caserta, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Massaro","sequence":"additional","affiliation":[{"name":"Department of Cardiology, ASST Lecco - A. Manzoni Hospital, Lecco, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluca","family":"Tiberti","sequence":"additional","affiliation":[{"name":"Department of Cardiology, ASST Lecco - A. Manzoni Hospital, Lecco, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Farina","sequence":"additional","affiliation":[{"name":"Department of Cardiology, ASST Lecco - A. Manzoni Hospital, Lecco, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scipione","family":"Carerj","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,7,30]]},"reference":[{"key":"R1-20260421","first-page":"2012","article-title":"Diagnosing the cause of chest pain","volume":"72","author":"Cayley","year":"2005","journal-title":"Am Fam Physician"},{"key":"R2-20260421","first-page":"522","article-title":"Time is myocardium: The focus is ischemic time!","volume":"20","author":"Natanzon","year":"2018","journal-title":"Isr Med Assoc J"},{"key":"R3-20260421","doi-asserted-by":"crossref","first-page":"e618","DOI":"10.1161\/CIR.0000000000000617","article-title":"Fourth universal definition of myocardial infarction (2018)","volume":"138","author":"Thygesen","year":"2018","journal-title":"Circulation"},{"key":"R4-20260421","doi-asserted-by":"crossref","first-page":"1846","DOI":"10.1016\/j.jacc.2019.02.018","article-title":"Type 2 myocardial infarction: JACC review topic of the week","volume":"73","author":"Sandoval","year":"2019","journal-title":"J Am Coll Cardiol"},{"key":"R5-20260421","doi-asserted-by":"crossref","first-page":"1569","DOI":"10.1016\/j.jacc.2017.07.784","article-title":"The many faces of type 2 myocardial infarction","volume":"70","author":"Januzzi","year":"2017","journal-title":"J Am Coll Cardiol"},{"key":"R6-20260421","doi-asserted-by":"crossref","first-page":"2999","DOI":"10.1093\/eurheartj\/ehr236","article-title":"ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The task force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC)","volume":"32","author":"Hamm","year":"2011","journal-title":"Eur Heart J"},{"key":"R7-20260421","doi-asserted-by":"crossref","first-page":"E5","DOI":"10.1002\/jhm.464","article-title":"A case of simultaneous pulmonary embolism and acute myocardial infarction secondary to a previously undiagnosed patent foramen ovale","volume":"4","author":"Budavari","year":"2009","journal-title":"J Hosp Med"},{"key":"R8-20260421","doi-asserted-by":"crossref","first-page":"3720","DOI":"10.1093\/eurheartj\/ehad191","article-title":"2023 ESC guidelines for the management of acute coronary syndromes","volume":"44","author":"Byrne","year":"2023","journal-title":"Eur Heart J"},{"key":"R9-20260421","doi-asserted-by":"crossref","first-page":"2129","DOI":"10.3390\/jcm12062129","article-title":"Role of intracoronary imaging in myocardial infarction with non-obstructive coronary disease (MINOCA): A review","volume":"12","author":"Borzillo","year":"2023","journal-title":"J Clin Med"},{"key":"R10-20260421","doi-asserted-by":"crossref","first-page":"5791","DOI":"10.3390\/jcm13195791","article-title":"Optical coherence tomography in myocardial infarction management: Enhancing precision in percutaneous coronary intervention","volume":"13","author":"Buonpane","year":"2024","journal-title":"J Clin Med"}],"container-title":["Journal of Cardiovascular Echography"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/jcecho.jcecho_75_24","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T19:45:28Z","timestamp":1787773528000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/jcecho.jcecho_75_24"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4]]},"references-count":10,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.4103\/jcecho.jcecho_75_24","relation":{},"ISSN":["2211-4122","2347-193X"],"issn-type":[{"value":"2211-4122","type":"print"},{"value":"2347-193X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4]]},"assertion":[{"value":"2024-10-17","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-12-29","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}