What does this research mean for the field?

In severe rheumatic mitral stenosis and atrial fibrillation with inadequate anticoagulation, coronary embolism causing ST-elevation myocardial infarction can mask a concurrent, fatal multisystem arterial embolic storm. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To describe a fatal presentation of catastrophic multisystem arterial thromboembolism initially masked by acute ST-elevation myocardial infarction and cardiogenic shock in a patient with rheumatic mitral stenosis.

July 26, 2026European Heart Journal - Case ReportsOpen Access

Catastrophic multisystem arterial thromboembolism masked by acute ST-elevation myocardial infarction and cardiogenic shock in a rheumatic mitral stenosis patient: A case report

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Rheumatic mitral stenosis, atrial fibrillation, STEMI, cardiogenic shock (n=1). Intervention: Subtherapeutic anticoagulation.

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Key result

Subtherapeutic anticoagulation in rheumatic mitral stenosis triggers fatal systemic embolic storm mimicking STEMI.

Why the study?

Severe rheumatic mitral stenosis with atrial fibrillation creates a highly thrombogenic substrate, where coronary embolism presenting as STEMI can mask simultaneous systemic arterial embolisation.

Population

A 60-year-old woman with severe rheumatic mitral stenosis, AF, and STEMI complicated by cardiogenic shock

Design

Case report

Authors

QTQuy Quoc Tran108 Military Central Hospital DDDuc Viet Dang108 Military Central Hospital DCDo Van Chien108 Military Central Hospital

Discussion

Member takes

Implication

Alerts to embolic storm risk in subtherapeutic anticoagulation for rheumatic MS with AF mimicking STEMI; leaves open systematic imaging protocols.

Key Points

To describe a fatal presentation of catastrophic multisystem arterial thromboembolism initially masked by acute ST-elevation myocardial infarction and cardiogenic shock in a patient with rheumatic mitral stenosis.
Clinical, angiographic, and computed tomography evaluation of a 60-year-old woman with severe rheumatic mitral stenosis, atrial fibrillation, and subtherapeutic anticoagulation presenting in cardiogenic shock.
Emergency coronary angiography was conducted with manual aspiration thrombectomy, followed by whole-body vascular assessment upon persistent clinical deterioration.
Initial laboratory and echocardiographic tests showed an INR of 1.43, high-sensitivity troponin T >10 000 ng/L, a mitral valve area of 0.96 cm2, and a left atrial volume index of 116 mL/m2.
Coronary angiography demonstrated thrombotic occlusions of multiple distal coronary branches without underlying atherosclerosis, where manual aspiration thrombectomy restored TIMI grade 3 flow.
Computed tomography angiography revealed extensive multisystem arterial thromboembolism involving the superior mesenteric artery, abdominal aorta, splenic artery, bilateral renal arteries, and bilateral iliac arteries, leading to fatal multiorgan failure.

Study Design

Type

Case Report (n=1)

Structured PICO

Population

A 60-year-old woman with severe rheumatic mitral stenosis, atrial fibrillation, and subtherapeutic anticoagulation who presented with STEMI and cardiogenic shock.

Exposure

Manual aspiration thrombectomy, continuous renal replacement therapy, and vasopressor/inotropic support (dobutamine and norepinephrine).

Outcome

Death due to refractory multiorgan failure.hard clinical

In patients with rheumatic mitral stenosis and atrial fibrillation, STEMI with distal multivessel occlusions may indicate a catastrophic systemic embolic storm requiring urgent vascular imaging.

Limitations

Transoesophageal echocardiography was not performed due to haemodynamic instability.
Diagnostic anchoring after coronary reperfusion delayed the recognition of systemic embolization.

Cite This Study

Tran et al. (2026) conducted a case report in Rheumatic mitral stenosis, atrial fibrillation, STEMI, cardiogenic shock (n=1). Subtherapeutic anticoagulation was evaluated. In a patient with advanced rheumatic mitral stenosis and atrial fibrillation, subtherapeutic anticoagulation led to a fatal systemic embolic storm initially masked as STEMI and cardiogenic shock.

synapsesocial.com/papers/6a65a7b4d3aea3239cd78642 https://doi.org/10.1093/ehjcr/ytag559

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Implication

Alerts to embolic storm risk in subtherapeutic anticoagulation for rheumatic MS with AF mimicking STEMI; leaves open systematic imaging protocols.

Catastrophic multisystem arterial thromboembolism masked by acute ST-elevation myocardial infarction and cardiogenic shock in a rheumatic mitral stenosis patient: A case report

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Limitations

Cite This Study

Catastrophic multisystem arterial thromboembolism masked by acute ST-elevation myocardial infarction and cardiogenic shock in a rheumatic mitral stenosis patient: A case report

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Limitations

Cite This Study

Also Consider

Also Consider