Introduction:
Nonatherosclerotic causes of STEMI may be life-threatening and can occur
even in the absence of significant cardiovascular risk factors. A
nonathersclerotic direct coronary thromboembolism is a rare occurrence.
It requires further investigation and the initiation of appropriate
therapy immediately.
Coronary embolism occurs in about 3% of patients with acute coronary
syndrome [1]. It may be paradoxical, direct, or iatrogenic. An
embolism breaks off an initial source such as a thrombus and then causes
a decrease or blockage of blood flow up stream.
Oral contraceptive pills (OCPs) are used widely to prevent unwanted
pregnancies and dysfunctional uterine bleeding. There has been much
research on the increased risk of thromboembolic events from these
drugs. Norgestimate / Ethinyl Estradiol is a progesterone and estrogen
combination used to prevent ovulation and pregnancy. OCPs including
Norgestimate / Ethinyl Estradiol are known to significantly increase the
risk of clot formation in female smokers who are above the age of 35
[2].
Herein we report a 41-year-old female who presented with an inferior
STEMI and was found to have a saddle clot (thrombus) involving the
distal left main artery, left circumflex, and proximal LAD. Her only
cardiac risk factors were smoking and the use of oral contraceptives.