A CASE OF ACUTE MYOCARDIAL INFARCTION DUE TO LEFT ATRIAL THROMBUS

Abstract

A 72-year-old male with chronic atrial fibrillation admitted to our hospital. He was treated with warfarin scince pulmonary infarction occured when he was operated on for descending colon cancer in April 1999. He had discontinued warfarin to pull out his rotten tooth for one week and had anterior chest pain in December 6, 1999. Electrocardiogram suggested acute inferior infarction and emergent coronary angiography revealed obstruction of right coronary artery at segment 3. But the thrombus of coronary artery migrated to the distal site of segment 4 PD after inserting PTCA baloon before inflation. There was no residual stenosis at the occluded site. PTCR with rt-PA was performed only to fail. Coronary angiogram showed no organic stenosis of right coronary artery after 19 days. Echocardiogram could not detect the organic change of mitral valve and left atrial thrombus. But there was smoke like echo pattern in left atrium and flow velocity of left atrial appendage decreased moderately. These findings suggested that the cause of myocardial infarction was coronary thromboembolism and we may need anticoaglants in non valvular atrial fibllilation.