Since it was first described in 1877, paradoxical embolism has become widely accepted as an etiology of stroke and peripheral vascular thrombotic occlusion. Less common are paradoxical emboli to the coronary artery. On the basis of limited pathologic and clinical series, it appears that paradoxical coronary emboli account for 5%–10% of all paradoxical emboli. Paradoxical coronary emboli have been described in all age groups, from neonates to the elderly, reflecting a wide spectrum of cardiac structural abnormality and clinical circumstance. Strategies for management should focus on treatment of acute coronary occlusion as well as prevention of future emboli.