Acute myocardial infarction secondary to suspected paradoxical emboli through patent foramen ovale in a young woman

A 40-year-old woman presented with an extensive anterior myocardial infarction. After initial thrombolytic therapy, coronary angiography was performed a few days later revealing normal coronaries with severe left ventricular dysfunction secondary to anterior wall akinesia. Echocardiography showed severe left ventricular systolic dysfunction and a patent foramen ovale (PFO). The patient had a history of long-term oral contraceptive consumption. A paradoxical embolus into the left coronary artery via a large PFO was suspected and was successfully treated with PFO closure.