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[Myocardial infarct in a young man with angiographically normal coronary arteries and atrial septal defect].

The paper is a case report of a 34 year old man with an inferior wall myocardial infarction, episodes of ventricular tachycardia, normal coronary arteries and a large atrial septal defect. Coronary atherosclerosis causes 95% of all myocardial infarcts and 75% in the age group under 35 years. Other possible causes are coronary arteritis, trauma, valuvlopathy, systemic diseases, infective and non-infective endocarditis, polycithemia, thrombocytosis, cocaine abuse. These can be usually excluded by history, physical or laboratory examination. The existence of a large atrial septal defect with dominantly left to right shunting, but occasional right to left shunting, is an indication and a justification for surgical treatment aiming to prevent recurrence by closure of the atrial septal defect. Paradoxical emboli have been recognised in the recent literature as an important cause of cerebral infarction, more rarely of emboli to other locations. The etiology remains difficult to confirm with certitude except when an embolus is seen by echocardiography in transit through a patent foramen ovale. We have also reviewed previously published cases of paradoxical emboli in literature.