Coronary Embolus: An Underappreciated Cause of Acute Coronary Syndromes

Claire E. Raphael, John A. Heit, Guy S. Reeder, Melanie C. Bois, Joseph J. Maleszewski, R. Thomas Tilbury, David R. Holmes

Research output: Contribution to journalReview articlepeer-review

45 Scopus citations


Coronary embolism is the underlying cause of 3% of acute coronary syndromes but is often not considered in the differential of acute coronary syndromes. It should be suspected in the case of high thrombus burden despite a relatively normal underlying vessel or recurrent coronary thrombus. Coronary embolism may be direct (from the aortic valve or left atrial appendage), paroxysmal (from the venous circulation through a patent foramen ovale), or iatrogenic (following cardiac intervention). Investigations include transesophageal echocardiography to assess the left atrial appendage and atrial septum and continuous electrocardiographic monitoring to assess for paroxysmal atrial fibrillation. The authors review the historic and contemporary published data about this important cause of acute coronary syndromes. The authors propose an investigation and management strategy for work-up and anticoagulation strategy for patients with suspected coronary embolism.

Original languageEnglish (US)
Pages (from-to)172-180
Number of pages9
JournalJACC: Cardiovascular Interventions
Issue number2
StatePublished - Jan 22 2018


  • coronary embolism
  • coronary embolus
  • paradoxical

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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