Acute inferior ST-segment elevation myocardial infarction and previous cryptogenic stroke caused by a paradoxical embolism with a concomitant pulmonary embolism

A 61-year-old patient suffered sudden acute ST-segment elevation myocardial infarction (STEMI) after stool, who only took thrombus aspiration by percutaneous coronary intervention (PCI) and got reperfusion totally, without balloon dilatation or stenting. While bilateral pulmonary embolism and deep venous thrombosis (DVT) was found on this patient, warfarin and inferior vena cava filter were used to antithrombotism. From the results of echocardiography, we noticed right ventricular enlargement and pulmonary hypertension, and the retrograde flow was detected at the foramen ovale, which meant patent foramen ovale (PFO), so it was considered that the thrombus caused acute myocardial infarction (AMI) was origianted from DVT through the foramen ovale. This rare case showed the importantce to define the source of the thrombus to find appropriate treatments and effective preventive measures.