Coronary heart disease is a major cause of mortality and morbidity worldwide. The incidence of mechanical complications of acute myocardial infarction (AMI) has gone down to less than 1% since the advent of percutaneous coronary intervention, but although mortality resulting from AMI has gone down in recent years, the burden remains high. Mechanical complications of AMI include cardiogenic shock, free wall rupture, ventricular septal rupture, acute mitral regurgitation, and right ventricular infarction. Detailed knowledge of the complications and their risk factors can help clinicians in making an early diagnosis. Prompt diagnosis with appropriate medical therapy and timely surgical intervention are necessary for favorable outcomes.

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None of the biomarker identifies a subgroup of patients who can be managed as an outpatient versus patients who may get benefit from thrombolytics with certainty; however, H-FABP and hs-cTnT showed some promising results and should be investigated further.

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Abiotrophia defectiva or nutritionally variant Streptococcus (NVS) is rare but important cause of infective endocarditis. We present a case of a 40 year old man with history of aortic valve replacement 14 years ago admitted for fever and chills. Blood culture grew A. defectiva in 4 out of 4 bottles. Patient became a febrile within few days after staring Ceftriaxone but subsequently had renal infarct due to septic embolization. Echocardiogram showed vegetations on aortic valve but no significant aortic regurgitation. After an 8 weeks course of Penicillin and Gentamicin was completed the patient had severe aortic regurgitation. Finally, aortic valve replacement and aortic root replacement was performed and patient did well after the surgery. Clinicians should be aware of this fastidious and aggressive organism when dealing with infective endocarditis. Complications rates are very high even on antibiotics and surgical treatment is needed in at least 50% of the cases.

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