STEMI and CVA in Hypercoagulable State with Ostium Secundum Defect

Mohammed Al-Sadawi¹, Bader Madoukh², Ayman Battisha³, Shakil Shaikh¹, Jonathan Marmur¹, Fadi Yacoub¹ and Samy I. McFarlane^4,

¹State University of New York: Downstate Medical Center

²Overland Park Regional Medical Center-HCA Midwest Health

³UMMS-Baystate Medical Center

⁴SUNY-Downstate, Brooklyn, New York USA

Cite this paper:
Mohammed Al-Sadawi, Bader Madoukh, Ayman Battisha, Shakil Shaikh, Jonathan Marmur, Fadi Yacoub and Samy I. McFarlane. STEMI and CVA in Hypercoagulable State with Ostium Secundum Defect. American Journal of Medical Case Reports. 2019; 7(12):320-324. doi: 10.12691/ajmcr-7-12-5

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.

Keywords:
hypercoagulability atrial septal defect myocardial infarction cerebrovascular accident

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