Acute Myocardial Infarction Revealing a Patent Foramen Ovale in a 37-Year-Old with a History of Unexplored Transient Ischemic Attack: A Case Report

Introduction A patent foramen ovale (PFO) is a common congenital anomaly that can lead to severe complications through paradoxical embolism, particularly in young patients with no classical cardiovascular risk factors. Myocardial infarction with non-obstructive coronary arteries (MINOCA) represents a minority of acute coronary syndrome cases but is clinically significant due to its heterogeneous and often unclear etiologies. Among these, PFO-related paradoxical embolism is a rare but critical cause requiring prompt recognition and management. Case Presentation We report the case of a 37-year-old man with no cardiovascular risk factors, presenting with acute chest pain and dyspnea. His medical history revealed a transient ischemic attack (TIA) at age 25, which had remained unexplored. At presentation, the patient exhibited signs of an acute myocardial infarction (ST-elevation in inferior leads and elevated troponin). Coronary angiography revealed non-obstructive coronary lesions, confirming MINOCA. Echocardiographic evaluation identified a PFO with a right-to-left shunt, while cardiac MRI findings were consistent with ischemia in the infero-basal myocardium. The diagnosis of MINOCA secondary to paradoxical embolism through the PFO was established. The patient was treated with anticoagulation (Rivaroxaban) and underwent successful percutaneous PFO closure. Discussion MINOCA is a multifactorial clinical entity requiring advanced diagnostic tools to uncover its etiology. In this case, the detection of a PFO linked the myocardial infarction to the patient’s prior unexplained TIA, supporting a paradoxical embolic mechanism. Cardiac magnetic resonance imaging played a pivotal role in confirming the ischemic nature of the event, while intracoronary OCT ruled out significant plaque instability. Percutaneous closure of the PFO was performed to prevent recurrent embolic events. Although commonly indicated for cryptogenic strokes, PFO closure in MINOCA patients remains less established and highlights the need for further research to guide management. Conclusion The discovery of a PFO in the context of myocardial infarction in a young patient without pre-existing coronary disease highlights the need for thorough evaluation of underlying causes. Management includes pharmacological treatment and close monitoring, with PFO closure as a potential option to prevent future thromboembolic events.