Acute ST‐elevation myocardial infarction due to septic embolism: A case report and review of management options

Abstract

Acute ST-elevation myocardial (STEMI) infarction due to septic embolism is rare and management strategies differ from those applied to atherothrombotic STEMI. A 70-year-old male with aortic valve endocarditis and persistent bacteremia developed acute inferior wall STEMI due to septic embolism. Due to inferior STEMI accompanied by hemodynamic instability, coronary angiography and primary PCI (stenting) to a totally occluded right coronary artery (RCA) was performed. Despite excellent immediate angiographic results and hemodynamic stabilization, repeat angiogram two weeks later showed mycotic aneurysms at the site of stent placement. Patient later suffered from intracranial hemorrhage and splenic infarct and had worsening aortic regurgitation, prompting surgical aortic valve replacement with bypass of the RCA. Despite aggressive medical, interventional and surgical management, he expired four weeks after the surgery. Selection of an optimal revascularization strategy in this scenario is unclear with a potential harm from standard therapies. We have reviewed prior reports and summarized results in a tabular form.

Acute myocardial infarction due to vegetation in a 13‐year‐old girl

“…Septic embolization to the coronary artery is a rare complication . In the present case, we speculate that a turbulent flow occurred because of a congenital aneurysm in the sinus of Valsalva, resulting in infective endocarditis.…”

Embolic ST-elevation Myocardial Infarction from Candida Endocarditis

“…These procedures increase the risk of distal embolization and dilation site infection. Stent placement particularly can increase the risk of mycotic aneurysm development due to intimal disruption and microbial seeding [15][16]. Therefore, aspiration thrombectomy appears to be a safer approach [17][18][19][20].…”

Simultaneous Right-Sided and Left-Sided Infective Endocarditis: Management Challenges in a Multidisciplinary Setting

“…Myocardial infarction caused by septic emboli is a known but uncommon complication of IE. 25,26 Given this patient's young age, lack of additional risk factors, and lack of critical coronary disease, this was determined to be the most likely diagnosis.…”

“…Myocardial infarction may be caused by a variety of reasons related to IE, including coronary obstruction from septic emboli, an aortic valve vegetation leading to ostial occlusion, and abscess-engendered coronary compression. 1,2,25,26 In summary, the presented case elucidates a number of the key echocardiographic and perioperative issues for the cardiac anesthesiologist caring for a patient with IE presenting for surgery. The patient requiring IE-related cardiac surgery requires a disciplined and comprehensive TEE examination before CPB, with a focus on corroborating the preoperative echocardiographic findings and seeking out additional IErelated cardiac complications.…”