Unusual presentation of endocarditis as inferior STEMI

Wojciuk, Jerzy; Goode, Grahame K.; More, Ranjit

doi:10.1093/eurheartj/ehs193

Cited by 6 publications

(4 citation statements)

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“…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].…”

Section: Discussionmentioning

confidence: 99%

Embolic ST-elevation Myocardial Infarction from Candida Endocarditis

Ghazzal

Gill

Radwan

et al. 2020

Cureus

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Infective endocarditis in intravenous drug users is uncommon in left-sided native valves. Adding to the rarity, in this case, is endocarditis from Candida species complicated by ST-elevation myocardial infarction. Embolic myocardial infarction has worse outcomes as compared to other etiologies, and the management of septic embolic myocardial infarction is rather challenging. The management of embolic myocardial infarction from Candida endocarditis vegetation includes antifungal therapy. The use of anti-thrombotic therapy and anticoagulation carries a significant risk of fatal neurologic complications and has been controversial, with limited observational data available. Among percutaneous coronary interventions, balloon angioplasty and stenting have been associated with multiple complications while aspiration embolectomy appears to be a safer option. Surgical management is considered if medical and interventional therapies fail or if there is an indication for valve replacement.

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Section: Discussionmentioning

confidence: 99%

Embolic ST-elevation Myocardial Infarction from Candida Endocarditis

Ghazzal

Gill

Radwan

et al. 2020

Cureus

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“…3 Less frequently, coronary embolism has been reported as the initial finding at presentation of undiagnosed IE. [4][5][6] It most often occurs with Streptococcus species and usually involves the LAD. 7 Acute MI from suspected septic embolism raises certain management concerns.…”

Section: Discussionmentioning

confidence: 99%

Gemella Endocarditis Presenting as an ST-Segment-Elevation Myocardial Infarction

Winkler¹,

Chaudhry²,

Stockwell³

2016

Texas Heart Institute Journal

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Presenting as an ST-Segment-Elevation Myocardial InfarctionAcute myocardial infarction from septic embolization is a rare initial presentation of endocarditis. We report the case of a 67-year-old S eptic embolization causing an ST-segment-elevation myocardial infarction (STEMI) is a rare initial presentation of infective endocarditis (IE). We present a case of coronary embolization in a patient with undiagnosed IE. We review therapeutic options in this situation and highlight the importance of including endocarditis as a potential cause of acute myocardial infarction (MI). Case ReportIn October 2014, a 67-year-old man whose medical history included hypertension, hyperlipidemia, and diabetes mellitus presented at our emergency department with the chief report of sharp, nonradiating, substernal chest pain in association with nausea and diaphoresis.The patient's vital signs upon admission were a temperature of 37 °C, a heart rate of 110 beats/min, a blood pressure of 194/107 mmHg, and an oxygen saturation of 100% on room air. An electrocardiogram showed a right bundle branch block with anterolateral ST-segment elevations and reciprocal inferior ST-segment depressions. Laboratory results were notable for a white blood cell count of 13.3 ×10 9 /L, a creatinine level of 1.44 mg/dL, and a troponin level of 0.26 ng/mL. The patient was treated with aspirin, clopidogrel, and heparin. Emergency cardiac catheterization revealed a culprit 95% lesion at the bifurcation of the left anterior descending coronary artery (LAD) and first diagonal artery (Fig. 1). The catheterization was complicated by distal emboli to both vessels. The absence of substantial atherosclerotic plaque on angiography raised the possibility of coronary embolism.The next day, a transthoracic echocardiogram revealed a left ventricular ejection fraction of 0.30 to 0.35 and a 6 × 3.7-mm mobile, echodense structure attached to the mitral valve, consistent with vegetation (Fig. 2). The patient's hospital course was significant for persistent fevers, the initiation of antibiotic therapy, and blood cultures positive for Gemella. He was also given milrinone and diuretic agents as post-MI and heart-failure therapy. Before his discharge from the hospital after 21 days, a transesophageal echocardiogram showed a 3.3 × 2.2-mm vegetation on scallop A2 of the mitral valve with associated leaflet perforation and mild mitral regurgitation (Fig. 3). It was decided to treat the condition medically for 6 weeks. However, the patient returned to the hospital 15 days later and died within 2 days of severe heart failure and septic shock secondary to a central-line infection. DiscussionThis report describes what we think is the first instance of Gemella endocarditis initially presenting as acute anterior STEMI from coronary artery embolization.Septic coronary embolism was first established through autopsy studies in patients with IE.

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“…However, the use of stenting to optimize the lumen diameter may result in the formation of mycotic aneurysms as described in this case. Recently, the use of aspiration thrombectomy (or aspiration embolectomy) for aspiration of septic embolus has been described with favorable results . Dekam et al reported complete resolution of stenosis with aspiration thrombectomy alone, whereas stent placement was required in other cases in addition to aspiration thrombectomy .…”

Section: Discussionmentioning

confidence: 99%

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

Singh

Mishra

Kaluski

2015

Cathet Cardio Intervent

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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.

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Unusual presentation of endocarditis as inferior STEMI

Cited by 6 publications

References 0 publications

Embolic ST-elevation Myocardial Infarction from Candida Endocarditis

Embolic ST-elevation Myocardial Infarction from Candida Endocarditis

Gemella Endocarditis Presenting as an ST-Segment-Elevation Myocardial Infarction

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

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