Coronary Artery Embolism - Etiology and Scoring Etiology: • Direct: Clot (LV thrombus, LAA Thrombus), Valve (Vegetation, Thrombus, Fibroelastoma), Mass (Myxoma, Rhabdomyosarcoma) • Paradoxical: Right to Left from Venous System/Right Heart, Via PFO or Interatrial Shunt • Iatrogenic: s/p Coronary Angiography or Cardiac Surgery - Most Common Cause Scoring: Major: • Angiographic evidence of coronary embolus (CE) w/o significant atherosclerosis • Concomitant coronary emboli in multiple coronary vascular territories • Concomitant systemic embolization Wlo LV thrombus attributable to acute MI • Histologic evidence of venous origin of CE material • Evidence of an embolic source based on TTE, TEE, CT or MRI Minor: • < 25% stenosis on coronary angiography in the non-culprit vessels • Atrial Fibrillation • Presence of embolic risk factors: cardiomyopathy, rheumatic valve disease, prosthetic valve, PFO, ASD, h/o of cardiac surgery, endocarditis or hypercoaguable state Scoring: • Definite: (>2 Major Criteria) OR (1 Major + ≥ 2 Minor) OR (3 Minor) • Probable: (1 Major + 1 Minor Criteria) OR (2 minor) - Cardionerds - Karan Desai MD, MPH @karanpdesai #Coronary #Artery #Embolism #diagnosis #differential #scoring #criteria #cardiology
