["Cryptogenic" coronary embolism - Case 4/2011].

History And Admission Findings: We report on a 42-year-old patient who presented with acute chest pain which occurred during defaecation. History revealed no cardiovascular risk factors.

Investigations: ECG and laboratory testing showed an non-ST-elevation myocardial infarction (NSTEMI).

Diagnosis, Treatment And Course: Coronary angiography revealed an embolic occlusion of the ramus intermedius. As origin of the embolus a deep vein thrombosis and a persistent foramen ovale (PFO) was diagnosed. We occluded the PFO with an Amplatz occluder. Because of the traumatic deep vein thrombosis phenprocoumon and clopdiogrel were given for 6 months.

Conclusions: Patients with no cardiovascular risk profile, who present with typical chest pain, an embolic cause is an important differential diagnosis. Especially history is very helpful for the correct diagnosis. Interventional occlusion of PFO is a simple and safe approach for patients with symptomatic PFO regarding no permanent antithrombotic medication.