Marella Punnaiah C, Murarka Shishir, Talluri Siva K, Bashir Faran
Department of Internal Medicine, Banner Estrella Medical Center, Phoenix, AZ, USA.
N Am J Med Sci. 2012 Aug;4(8):373-5. doi: 10.4103/1947-2714.99524.
Infective endocarditis is a rare cause of coronary embolism. This can result in myocardial infarction. Prompt identification is necessary as management is different from a regular myocardial infarction. Unlike in regular myocardial infarction, use of thrombolytics in this scenario could result in life-threatening complications and hence not indicated. In a patient who appears to be septic, embolic myocardial infarction should always be in the working differential diagnosis. An early transesophageal echocardiogram and cardiac catheterization could assist in diagnosis and management. We present an interesting case of a 45-year-old man who was admitted with vision loss, fevers and was found to have a non-ST segment elevation myocardial infarction. He had persistent bacteremia and developed systemic emboli. Investigation revealed mitral valve vegetation and a cardiac catheterization showed an interesting "snake"-shaped embolic vegetation in right coronary artery. He was treated with surgery to the mitral valve and antibiotics. In a septic patient with myocardial infarction, possibility of coronary embolism from vegetation should be kept in mind.
感染性心内膜炎是冠状动脉栓塞的罕见病因。这可导致心肌梗死。由于其治疗方法与普通心肌梗死不同，因此需要及时识别。与普通心肌梗死不同，在此种情况下使用溶栓药物可能会导致危及生命的并发症，因此不适用。对于疑似败血症的患者，栓塞性心肌梗死应始终列入鉴别诊断范围。早期经食管超声心动图和心导管检查有助于诊断和治疗。我们报告一例有趣的病例，一名45岁男性因视力丧失、发热入院，被发现患有非ST段抬高型心肌梗死。他持续存在菌血症并出现全身栓塞。检查发现二尖瓣赘生物，心导管检查显示右冠状动脉有一个有趣的“蛇”形栓塞性赘生物。他接受了二尖瓣手术和抗生素治疗。对于患有心肌梗死的败血症患者，应考虑到赘生物导致冠状动脉栓塞的可能性。
