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August 8, 1959


Author Affiliations

Ridgewood, N. J.

From the departments of medicine, Hackensack Hospital, Hackensack, N. J., and Bergen Pines Hospital, Paramus, N. J.

JAMA. 1959;170(15):1802-1804. doi:10.1001/jama.1959.63010150001012

The occurrence of coronary embolus in a patient with rheumatic heart disease is an unusual complication. No means of differentiating it from acute coronary thrombosis exists.1 One should be suspicious of acute coronary embolus if the clinical picture of acute coronary thrombosis occurs in a young patient in whom advanced coronary disease is unlikely. This suspicion should be increased, especially, if the patient has not had angina pectoris and if auricular fibrillation and mitral stenosis are present.

The most frequent cause of coronary artery embolus is subacute bacterial endocarditis. Occlusion is more common in the left artery than in the right. Two-thirds of all patients with coronary embolus due to bacterial endocarditis die suddenly; the remaining third have a longer course which simulates acute myocardial infarction. When embolism is due to disease other than bacterial endocarditis, the outcome is always fatal, according to published reports.2

To establish that