Acute myocardial infarction as the first sign of infective endocarditis: a case report

Abstract

Infective endocarditis is a bacterial or fungal infection of the heart valves or endocardial surface, and it frequently forms vegetation and can lead to systemic embolism. Dislodged vegetation rarely results in coronary artery embolism (CAE) and subsequent acute myocardial infarction. A 43-year-old male patient was emergently brought to our hospital for suspected acute myocardial infarction. Coronary angiography was performed and it showed embolism in the left circumflex artery. Thrombus aspiration was performed during coronary angiography. Echocardiography showed formation of vegetation in the posterior leaflet of the mitral valve and multiple blood cultures showed Listeria monocytogenes. Infective endocarditis was diagnosed. Three weeks later, debridement of subacute bacterial endocarditis, mitral valve replacement, and tricuspid valvuloplasty were successfully conducted. Our findings suggest that CAE should be considered in the differential diagnosis of acute myocardial infarction. Aspiration of coronary embolus during coronary angiography followed by surgical intervention of diseased heart valves is a plausible strategy for managing CAE in infective endocarditis.

Pathophysiology of Myocardial Infarction With Nonobstructive Coronary Artery Disease: A Contemporary Systematic Review

“…Endocarditis of the mitral valve, Staphylococcus aureus or fungal infection, and vegetation size > 10 mm are predictors of coronary embolism in patients with infective endocarditis. 63 Marantic endocarditis also has been reported as an uncommon etiology of direct coronary embolism. 64 Among myxomas, those with a villiform surface, as opposed to smooth-surface myxomas, are more likely to be associated with direct coronary embolism.…”

Myocardial Infarction With Non-obstructive Coronary Arteries: Risk Factors and Associated Comorbidities

“…Another peculiar cause of MINOCA is coronary embolisation of an endocardial vegetation fragment. Despite its rarity—observational studies have shown that the incidence of coronary embolism during infective endocarditis approximates 0.5%—, it constitutes a potentially lethal complication ( 51 ). Oftentimes, a septic embolus is not visible on coronary angiography owing to its microvascular localisation, but should be suspected in this specific clinical setting, especially in case of multiple embolic events.…”