[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 35.173.234.169. Please contact the publisher to request reinstatement.
[Skip to Content Landing]

A Middle-Aged Woman With Non–ST-Elevation Myocardial Infarction and Unobstructed Coronary Arteries

A middle-aged woman with a history of completed myocardial infarction and left-sided paresthesias presented with chest pain and elevated troponin T levels (1037 ng/L; normal levels, <14 ng/L).

Coronary angiography demonstrated unobstructed coronary arteries; cardiac magnetic resonance imaging suggested edema from acute infarction at the site of a previous infarction; and a transthoracic echocardiogram saline contrast study (ie, bubble study) demonstrated color flow at rest across the interatrial septum and a large shunt on Valsalva maneuver consistent with a grade 3 patent foramen ovale (PFO). Brain magnetic resonance imaging revealed bilateral white matter lesions thought to be secondary to small vessel disease greater in number than expected for the patient's age, raising suspicion for microemboli.

She was diagnosed with paradoxical embolism through a PFO causing recurrent systemic embolism and was treated with PFO closure and 6 months of antiplatelet therapy. Click the Related Article for a complete discussion.

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
Close
With a personal account, you can:
  • Track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
jn-learning_Modal_SaveSearch_NoAccess_Purchase
Close

Lookup An Activity

or

Close

My Saved Searches

You currently have no searches saved.

Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close