Abstract
Atrial septal defect (ASD) is a risk factor for multiple vascular thrombotic events, which can occur either sequentially or simultaneously. In this report we present a case of ST-elevation myocardial infarction (STEMI) and cerebrovascular accident (CVA). The severity of adverse cardiovascular or cerebrovascular events can be increased by the presence of specific type of ASD, such as a patent foramen ovale (PFO) or osteum secundum defect. This case report discusses a unique presentation of a 48-year old male on warfarin therapy for a history of cerebral venous thrombosis (CVT) who subsequently presented with simultaneous STEMI with CVA, and who was incidentally found to have an ostium secundum defect on echocardiography. He was emergently taken for cardiac catheterization, which revealed significant proximal LAD occlusion. There has been a long standing debate within the international scientific communities regarding the therapeutic benefit of PFO closure for long-term secondary prevention of recurrence CVA. We discuss the different points of view regarding PFO closure for secondary prevention of CVA with a review of the literature on this rather controversial topic.
Highlights
Patent Foramina Ovale (PFO) has a prevalence of 25-30% within the population and has important implications in the occurrence of cryptogenic strokes, which account for one-fourth of all ischemic strokes. [1] The pathophysiological mechanism is entry of an embolized clot into the systemic arterial circulation via the PFO. [2] the risk of these events is accentuated by the presence of a hypercoagulable state, such as protein S deficiency or autoimmune disease such as lupus
We present the case of a patient who experienced a myocardial infarction and cerebrovascular accident (CVA) who was on warfarin therapy for a prior history of cerebral venous thrombosis, and who was incidentally found to have an ostium secundum defect on echocardiography
The patient may have benefited from genetic testing of hypercoagulable disorders, our focus will be on the manifestations of vascular thrombotic events in more than one site of the body as well as present the literary evidence in favor of atrial septal defect closure to maximize risk reduction of recurrence of these events
Summary
Patent Foramina Ovale (PFO) has a prevalence of 25-30% within the population and has important implications in the occurrence of cryptogenic strokes, which account for one-fourth of all ischemic strokes. [1] The pathophysiological mechanism is entry of an embolized clot into the systemic arterial circulation via the PFO. [2] the risk of these events is accentuated by the presence of a hypercoagulable state, such as protein S deficiency or autoimmune disease such as lupus. [2] the risk of these events is accentuated by the presence of a hypercoagulable state, such as protein S deficiency or autoimmune disease such as lupus. Both venous and arterial circulations are at risk of thrombosis in these contexts. We discuss the case of a patient who fits the paradigm of clotting in both venous and arterial circulation due to the following constellation of underlying predisposing factors: septum secundum defect, protein S deficiency, and lupus anticoagualnt. The patient may have benefited from genetic testing of hypercoagulable disorders, our focus will be on the manifestations of vascular thrombotic events in more than one site of the body as well as present the literary evidence in favor of atrial septal defect closure to maximize risk reduction of recurrence of these events
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