Acute coronary embolism complicating bacterial endocarditis: Operative treatment

Pfeifer, James F.; Lipton, Martin J.; Oury, James H.; Angell, William W.; Hultgren, Herbert N.

doi:10.1016/0002-9149(76)90119-3

Cited by 32 publications

(9 citation statements)

References 16 publications

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“…1,2 There are obvious concerns in deciding how to treat coronary emboli in the setting of endocarditis, including the usage of thrombolytics or anticoagulation, yet this issue is seldom addressed in the literature. We present two patients with acute myocardial infarction (MI) in the setting of infective endocarditis and outline principles of management of this rare complication.…”

Section: Introductionmentioning

confidence: 99%

Managing embolic myocardial infarction in infective endocarditis: current options

Khan

Khakoo

Failinger

2005

Journal of Infection

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Section: Introductionmentioning

confidence: 99%

Managing embolic myocardial infarction in infective endocarditis: current options

Khan

Khakoo

Failinger

2005

Journal of Infection

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“…In 1972, Pfeifer was the first to describe a successful surgical reperfusion of the LAD in a patient with MI due to septic coronary embolus [8]. Thrombolysis was later attempted with, over the years, periodic case reports of fatal intracerebral haemorrhages probably due to undetected cerebral mycotic aneurysms, such that it is now considered a relative contraindication [9,10].…”

Section: Discussionmentioning

confidence: 99%

"The plug and the bug"- a case of coronary embolism in bacterial endocarditis

2014

Cardiovasc Med

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SummarySystemic embolism is a classic complication of infective endocarditis. Coronary involvement and acute myocardial infarction (MI) are rare and increase mortality significantly. Recognising this unusual entity is crucial to provide adequate care. Percutaneous coronary intervention and thrombus aspiration is preferred to thrombolysis, which classically increases intracerebral haemorrhage risk. The present article describes the case of an acute inferior ST-elevated MI due to a Streptococcus salivarius endocarditis in a patient with known bicuspid aortic valve.Key words: bacterial endocarditis; septic embolism; coronary embolism; myocardial infarct Case reportA 79 year-old female with prior history of hypertension and moderate aortic insufficiency due to bicuspid aortic valve presented to the emergency department with STelevation myocardial infarction (MI). She complained of acute retro-sternal chest pain and left arm radiation of 2 hours duration. T he presentation followed a one-month period of fatigue, weight-loss and progressive dyspnea. Physical examination revealed an acutely ill lady. Non invasive blood pressure was 150/60 mm Hg on both sides; pulse regular at 100 beats per minute; respiratory rate at 20/minute; saturation 97% under 2L/min oxygen and temperature was 37.9 °C. Significant signs were a rapid upstroke followed by quick collapse of peripheral pulses, an enlarged hyperdynamic cardiac apical impulse, a blowing pandiastolic decrescendo murmur in the left upper sternal border, a midsystolic ejection murmur with carotid radiation and no extra heart sounds. Pulmonary auscultation was consistent with bilateral basal crackles. Chest radiograph revealed a marked cardiomegaly and dilation of the aortic knob and root but no signs of widened mediastinum or pulmonary congestion. Troponin Ic was 0.35 ug/L, white blood cell count of 13.5 G/L with normal differential and a C-reactive protein of 60 mg/L, and the rest of the laboratory work-up was unremarkable.On arrival, the 12-lead electrocardiogram (ECG) showed normal sinus rhythm, first-degree atrioventricular block and a 2 mm ST-elevation in leads II, III avF, V5 and V6 ( fig. 1A). Therapy was initiated with aspirin 500 mg, heparin 5000 U and clopidogrel 600 mg. An urgent coronary angiography revealed the distal occlusion of a marginal branch of the circumflex artery but otherwise normal coronary arteries ( fig. 1B). The aortogram showed significant ascending aorta dilatation ( fig. 1C) as well as severe aortic valve regurgitation. The left ventricular ejection fraction was deemed normal with inferolateral hypokinesia. Considering the history and presentation, a septic embolus was thought to be the cause of the occlusion and, due to vessel tortuosity, distal lesion and spontaneous symptom alleviation no intravascular treatment was attempted. Peak troponin Ic was 12.3 ug/L and total CK 545 U/L. Four different peripheral blood cultures grew penicillin sensitive Streptococcus salivarius (minimum inhibitory concentration <0.125 mg/L). A trans-oesophageal ech...

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“…Also, vegetations are more resistant than fresh thrombi to PTCA intervention so that the chance of success compared to PTCA is decreased (1,(7)(8)(9). Another possible alternative solution in some challenging cases may be surgical (10).…”

Section: Discussionmentioning

confidence: 99%

Suspected Central Anticholinergic Syndrome Related to Sycloplegic Eye Drop in a Premature Baby

Gültekin¹,

Küçükateş²,

Bulut³

2012

Balkan Med J

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Acute coronary embolism complicating bacterial endocarditis: Operative treatment

Cited by 32 publications

References 16 publications

Managing embolic myocardial infarction in infective endocarditis: current options

Managing embolic myocardial infarction in infective endocarditis: current options

"The plug and the bug"- a case of coronary embolism in bacterial endocarditis

Suspected Central Anticholinergic Syndrome Related to Sycloplegic Eye Drop in a Premature Baby

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