Paradoxical embolism via a sinus venosus atrial septal defect causing an inferior ST-segment elevation myocardial infarction in a 23-year-old woman.

Cerebrovascular accidents constitute the most frequent clinical manifestation of paradoxical embolism. However, it is becoming increasingly recognised that acute myocardial infarction is also an important and potentially life-threatening clinical manifestation of paradoxical embolism. Various intracardiac or pulmonary shunts can provide a convenient conduit for an embolus to traverse from the venous vasculature into the systemic circulation with potentially devastating consequences. We present the case of a 23-year-old woman presenting with chest pain and ST-segment elevation myocardial infarction who ultimately was found to have a sinus venosus atrial septal defect associated with both partial anomalous pulmonary venous drainage and a persistent left superior vena cava.

Right ventricle best predicts the race performance in amateur ironman athletes.

PURPOSE: The ironman (IM) triathlon is a popular ultraendurance competition, consisting of 3.8 km of swimming, 180.2 km of cycling, and 42.2 km of running. The aim of this study was to investigate the predictors of IM race time, comparing echocardiographic findings, anthropometric measures, and training characteristics. METHODS: Amateur IM athletes (ATHL) participating in the Zurich IM race in 2010 were included. Participants were examined the day before the race by a comprehensive echocardiographic examination. Moreover, anthropometric measurements were obtained the same day. During the 3 months before the race, each IM-ATHL maintained a detailed training diary. Recorded data were related to total IM race time. RESULTS: Thirty-eight IM finishers (mean ± SD age = 38 ± 9 yr, 32 men [84%]) were evaluated. Total race time was 684 ± 89 min (mean ± SD). For right ventricular fractional area change (45% ± 7%, Spearman ρ = -0.33, P = 0.05), a weak correlation with race time was observed. Race performance exhibited stronger associations with percent body fat (15.2 ± 5.6%, ρ = 0.56, P = 0.001), speed in running training (11.7 ± 1.2 km · h(-1), ρ = -0.52, P = 0.002), and left ventricular myocardial mass index (98 ± 24 g · m(-2), ρ = -0.42, P = 0.009). The strongest association was found between race time and right ventricular end-diastolic area (22 ± 4 cm2, ρ = -0.64, P < 0.0001). In multivariate analysis, right ventricular end-diastolic area (ß = -16.7, 95% confidence interval = -27.3 to -6.1, P = 0.003) and percent body fat (ß = 6.8, 95% confidence interval = 1.1-12.6, P = 0.02) were independently predictive of IM race time. CONCLUSIONS: In amateur IM-ATHL, RV end-diastolic area and percent body fat were independently related to race performance. RV end-diastolic area was the strongest predictor of race time. The role of the RV in endurance exercise may thus be more important than previously thought and needs to be further studied.