Page 20 - Delaware Medical Journal - February 2018

Criteria for Coronary Embolism (CE)
Major criteria
Angiographic evidence of coronary artery embolism and thrombosis without atherosclerotic components
Concomitant coronary artery embolization at multiple sites*
Concomitant systemic embolization without left ventricular thrombus attributable to acute myocardial infarction
Minor criteria
<25% stenosis on coronary angiography, except for the culprit lesion
Evidence of an embolic source based on transthoracic echocardiography, transesophageal echocardiography, computed tomography, or MRI
Presence of embolic risk factors: Atrial fibrillation, cardiomyopathy, rheumatic valve disease, prosthetic heart valve, patent foramen ovale, atrial septal defect, history of cardiac surgery, infective endocarditis, or hypercoagulable state
Definite CE
Two or more major criteria, or
One major criterion plus ≥2 minor criteria, or
Three minor criteria
Probable CE
One major criterion plus one minor criterion, or
Two minor criteria
A diagnosis of CE should not be made if there is:
Pathological evidence of atherosclerotic thrombus
History of coronary revascularization
Coronary artery ectasia
Plaque disruption or erosion detected by intravascular ultrasound or optic coherence tomography in the proximal part of the culprit lesion
Post cardiac catheterization echocardiogram revealing large mitral valve vegetation.
FIGURE 4
Severe mitral regurgitation.
FIGURE 5
FIGURE 6
You will find that our patient met 2 major and 3 minor criteria for coronary embolism. *Indicates multiple vessels within one coronary artery territory or multiple vessels in the coronary tree.
CONTRIBUTING AUTHOR
■ TAMER AMER, DO is a Resident in the Department of Medicine at Christiana Care Health System in Newark, Del.
Mycotic posterior cerebral aneurysm, further supporting coronary septic embolism as source for MINOCA.
52
Del Med J | February 2018 | Vol. 90 | No. 2