Multifactorial Hypercoagulability Causing Simultaneous STEMI and Pulmonary Embolism in Young Adults With Prothrombin G20210A Mutation

BACKGROUND: The simultaneous occurrence of ST-segment elevation myocardial infarction and pulmonary embolism is rare, especially in young individuals without known cardiovascular disease. Both presentations imply an underlying hypercoagulable state or paradoxical embolism. CASE SUMMARY: A 27-year-old man experienced cardiac arrest during exercise and was diagnosed with both ST-segment elevation myocardial infarction and pulmonary embolism. Tests revealed thrombotic occlusion of the left posterior descending artery, lower extremity deep venous thrombosis, pulmonary arteriovenous malformation, and heterozygous prothrombin gene mutation. He was treated with mechanical thrombectomy and anticoagulation. DISCUSSION: This case demonstrates simultaneous arterial and venous thrombosis, likely from inherited hypercoagulability amplified by dehydration, alcohol, tobacco, and trauma, though paradoxical embolism cannot be entirely excluded. TAKE-HOME MESSAGE: Comprehensive thrombophilia evaluation and systemic shunt exclusion are essential in young patients with concurrent arterial and venous thrombosis.