An Acute Coronary Syndromes (ACS) Revealing a Severe Mitral Stenosis: A Case Report

Background: Coronary artery embolization is an exceedingly rare cause of myocardial infarction, but a few cases in association with prosthetic mechanical valves have been reported. We report a case of embolic myocardial infarction in a patient with critical mitral stenosis and AF. Objective: Presenting a Rare co-existance of disease or pathology. Case Report: A 62-year-old man was admitted to the catheterization lab for early coronary intervention due to an ST-elevation myocardial infarction. His electrocardiogram showed ST elevation in leads II, III, and aVF, along with a Q wave of necrosis and atrial fibrillation. Coronary angiography revealed a complete blockage of the posterior descending artery with a thrombus. Following treatment with thrombo- aspiration and tirofiban, the thrombus was moved distally. Echocardiography identified severe mitral stenosis. The combination of angiographic findings, atrial fibrillation, and mitral stenosis confirmed coronary embolism as the underlying cause of the myocardial infarction. Anticoagulation therapy was started, and the patient was referred for mitral valve replacement. Conclusion: Coronary artery thromboembolism is a rare cause of acute coronary syndrome. Treatment typically involves intensive anticoagulation, antiplatelet therapy, and different interventional strategies. In this context, secondary prevention is crucial and includes educating patients on proper anticoagulation management with an oral vitamin K antagonist, as well as providing medical guidance on the potential risks of thromboembolism.