Clinical Practice and Cases in Emergency Medicine

Introduction: Paradoxical coronary embolism is a rare cause of myocardial infarction.

Case Report: A 57-year-old man presented with acute chest pain after a recent non-ST elevation myocardial infarction, during which a patent foramen ovale was identified. On readmission, the electrocardiogram showed an inferior ST-elevation myocardial infarction, and angiography revealed a distal thrombotic occlusion in otherwise normal coronary arteries. No venous thromboembolism was found, but thrombophilia testing revealed heterozygous factor V Leiden. He was managed conservatively and underwent successful patent foramen ovale closure.

Conclusion: This case highlights paradoxical embolism as a diagnostic consideration in acute myocardial infarction without coronary artery disease.