A case of acute myocardial infarction due to coronary embolism from left atrial thrombus with atrial fibrillation

A 55-year-old man, who has been on follow-up observation with chronic atrial fibrillation, came in with a sudden onset of chest pain on July 31, 1986. He was diagnosed as having acute myocardial infarction indicated by abnormal ECG, elevated serum enzyme and characteristic signs of echocardiography. Emergency coronary angiography was performed 2 hours after the onset of chest pain, and it was reported as showing total obstruction of the distal left anterior descending artery. Percutaneous transluminal coronary recanalization using 1,200,000 units of urokinase was unsuccessful. The repeated angiography performed 40 days later, showed normal coronary arteriogram, but left ventriculogram revealed akinesis of the apical segment. Furthermore, left atrium opacified in the levophase of pulmonary arteriogram indicated left atrial thrombus. The cause of the myocardial infarction was considered to be coronary embolism from the left atrial thrombus with atrial fibrillation. It must be the first report documented by coronary angiography, of coronary thrombo-embolism due to chronic atrial fibrillation without any underlying disease.