A case of coronary embolism in a patient with paroxysmal atrial fibrillation receiving tamoxifen

Coronary embolism is an uncommon cause of myocardial infarction which should be considered especially in patients with associated conditions like atrial fibrillation, intracardiac prosthesis or infective endocarditis. We present the case of a 64-year-old man with lone paroxysmal AF who sustained an acute anterior wall infarction due to an embolism in the LAD. The patient was being treated with tamoxifen for benign gynaecomastia. The case illustrates some therapeutic problems of embolic myocardial infarction. Rescue PTCA after unsuccessful thrombolysis first resulted in distal embolization in diagonal branches with the need for aggressive anticoagulation. While the final angiographic result was satisfactory, the patient died of an intracranial hemorrhage. We present a short overview of the therapeutic options of coronary embolism and discuss the effect of the selective estrogen receptor modulator tamoxifen on arterial and venous thromboembolic disease which is suggestive of a pathogenic role.