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Cerebrovascular accidents constitute the most frequent clinical manifestation of paradoxical embolism. However, it is becoming increasingly recognised that acute myocardial infarction is also an important and potentially life-threatening clinical manifestation of paradoxical embolism. Various intracardiac or pulmonary shunts can provide a convenient conduit for an embolus to traverse from the venous vasculature into the systemic circulation with potentially devastating consequences. We present the case of a 23-year-old woman presenting with chest pain and ST-segment elevation myocardial infarction who ultimately was found to have a sinus venosus atrial septal defect associated with both partial anomalous pulmonary venous drainage and a persistent left superior vena cava.

Paradoxical embolism via a sinus venosus atrial septal defect causing an inferior ST-segment elevation myocardial infarction in a 23-year-old woman