Discussion:
According to angiographic and autopsy data, various causes of coronary artery embolism have been reported in the literature [10]. Different studies reported various causes as the most common cause of coronary artery embolism. A study conducted by Charles et al. reported bacterial endocarditis as the common cause of coronary embolism, while Prizel et al. reported valvular heart diseases and cardiomyopathy as the common risk factors for causing coronary embolism [11, 12]. However, a recent study conducted by Popovic et al. reported atrial fibrillation as the most common cause of coronary artery embolism, followed by dilated cardiomyopathy and bacterial endocarditis respectively [13]. Similarly, Shibata et al. conducted a study on new-onset MI between 2001 to 2013 and reported that 2.9% of AMIs were due to coronary embolism, with the most prevalent cause reported was atrial fibrillation, followed by cardiomyopathy and valvular heart disease [10]. Very rarely, paradoxical embolism causing acute myocardial infarction has been reported in the literature [14].
Atrial fibrillation patients are at increased risk of left atrium thrombus formation, particularly in the left atrial appendage, through Virchow’s triad of blood stasis, endothelial damage, and hypercoagulable state. These patients benefit from anticoagulation and require life-long anticoagulation to prevent thrombus formation and associated complications. In our case, a patient was admitted with a chronic medical history of atrial fibrillation on anticoagulation with questionable compliance and was admitted with sepsis and takotasubo cardiomyopathy, and later complicated by AMI secondary to coronary embolism to the LAD. Multiple factors played their role in developing coronary embolism in our patients, with the most common being atrial fibrillation with questionable compliance with anticoagulation, followed by takotsubo cardiomyopathy. Coronary artery embolism secondary to takotsubo cardiomyopathy has been reported in the literature [15], and the typical apical ballooning form of takotsubo cardiomyopathy seems to be more vulnerable to thrombus formation, which then leads to various thromboembolic complications [16].