Acute Myocardial Infarction Secondary to Thrombosis in the Right Coronary Sinus of Valsalva

Abstract

A 78-year-old woman with a history of paroxysmal atrial fibrillation and hypertension presented with sudden chest pain, dyspnea, and severe hypoxia (O2 saturation=79%; arterial blood gas test results: Paco2 level=37.4 mm Hg and Pao2 level=46.1 mm Hg under high-flow oxygen administration). Electrocardiography showed ST elevation in the inferior leads. Transthoracic echocardiography showed hypokinesis of the right ventricular free wall and enlargement of the right ventricle with flattening of the interventricular septum during diastole (online-only Data Supplement Movie I). As clinical suspicion for pulmonary embolism associated with inferior myocardial infarction was high, emergent multidetector computed tomography (MDCT) was performed: no thrombi were found in the pulmonary artery, but a thrombus was observed in the right coronary sinus of Valsalva (Figure 1A and 1B). After MDCT, repeat echocardiography …