Chen Zhong, Ng Francesca, Nageh Thuraia
Department of Cardiology, London Chest Hospital, Bonner Road, London E2 9JX, UK.
Emerg Med J. 2007 Jun;24(6):442-3. doi: 10.1136/emj.2006.043000.
A 39-year-old Zimbabwean man presented with a 1 week history of fever, general malaise and acute-onset chest pain. He had a urethral stricture, which had been managed with an indwelling supra-pubic catheter. The electrocardiography on admission showed inferior ST-T segments elevation. His chest pain and electrocardiography changes resolved subsequent to thrombolysis, and he remained haemodynamically stable. The 12-h troponin I was increased at 10.5 microg/l (NR <0.04 microg/l). Echocardiography confirmed severe mitral regurgitation and a flail anterior mitral valve leaflet with an independently oscillating mobile vegetation. Enterococci faecalis were grown on blood cultures. A diagnosis of enterococci infective endocarditis with concomitant acute myocardial infarction due to possible septic emboli was made. Despite the successful outcome from thrombolysis in the setting of acute myocardial infarction with infective endocarditis, the case highlights the current lack of definitive data on the optimal acute management of such an unusual clinical scenario. Although there is serious concern that thrombolytic treatment for myocardial infarction in the setting of infective endocarditis may be associated with higher risk of cerebral haemorrhage, there is little documented evidence supporting the safety of primary percutaneous coronary intervention with these patients.
一名39岁的津巴布韦男子，有1周的发热、全身不适及急性胸痛病史。他患有尿道狭窄，一直通过留置耻骨上导尿管进行处理。入院时心电图显示下壁ST-T段抬高。溶栓治疗后，他的胸痛及心电图改变消失，血流动力学保持稳定。12小时肌钙蛋白I升高至10.5微克/升（正常范围<0.04微克/升）。超声心动图证实存在严重二尖瓣反流及二尖瓣前叶连枷样改变，伴有一个独立摆动的活动赘生物。血培养培养出粪肠球菌。诊断为粪肠球菌感染性心内膜炎，伴可能因脓毒性栓子导致的急性心肌梗死。尽管在感染性心内膜炎合并急性心肌梗死的情况下溶栓治疗取得了成功，但该病例凸显了目前对于这种不寻常临床情况的最佳急性处理缺乏确切数据。尽管人们严重担心在感染性心内膜炎情况下进行心肌梗死溶栓治疗可能会增加脑出血风险，但几乎没有文献证据支持这些患者进行直接经皮冠状动脉介入治疗的安全性。
