Author + information
- Received April 17, 2017
- Revision received August 3, 2017
- Accepted August 8, 2017
- Published online January 15, 2018.
- Claire E. Raphael, MBBS, PhDa,
- John A. Heit, MDa,b,
- Guy S. Reeder, MDa,
- Melanie C. Bois, MDc,
- Joseph J. Maleszewski, MDc,
- R. Thomas Tilbury, MDa and
- David R. Holmes Jr., MDa,∗ ()
- aDepartment of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
- bDivision of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
- cDepartment of Pathology, Mayo Clinic, Rochester, Minnesota
- ↵∗Address for correspondence:
Dr. David R. Holmes, Jr., Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905.
Coronary embolism is the underlying cause of 3% of acute coronary syndromes but is often not considered in the differential of acute coronary syndromes. It should be suspected in the case of high thrombus burden despite a relatively normal underlying vessel or recurrent coronary thrombus. Coronary embolism may be direct (from the aortic valve or left atrial appendage), paroxysmal (from the venous circulation through a patent foramen ovale), or iatrogenic (following cardiac intervention). Investigations include transesophageal echocardiography to assess the left atrial appendage and atrial septum and continuous electrocardiographic monitoring to assess for paroxysmal atrial fibrillation. The authors review the historic and contemporary published data about this important cause of acute coronary syndromes. The authors propose an investigation and management strategy for work-up and anticoagulation strategy for patients with suspected coronary embolism.
All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 17, 2017.
- Revision received August 3, 2017.
- Accepted August 8, 2017.
- 2018 American College of Cardiology Foundation
- Central Illustration
- Direct Coronary Embolism
- Paradoxical Coronary Embolism
- Iatrogenic Coronary Embolism
- Prevalence of Coronary Embolism
- Diagnosis and Management of Acute Coronary Embolism
- Is There a Role for Thrombophilia Testing in Patients With Coronary Embolism?
- Management of Coronary Embolism: Who to Anticoagulate and for How Long
- Empiric Recommendations for Investigation of Coronary Embolism
- Empiric Recommendations for Treatment of Coronary Embolism