Zaman Mumtaz, Loynd Richard, Donato Anthony
Sidney Kimmel Medical College at Thomas Jefferson University, USA.
Tower Health System, USA.
Case Rep Cardiol. 2019 Mar 3;2019:1348607. doi: 10.1155/2019/1348607. eCollection 2019.
Acute myocardial infarction due to a coronary embolic event can occur as a complication of infective endocarditis in up to 2.9% of cases and can frequently be the presenting symptom. A 35-year-old female presented with 4 hours of typical chest pain and was found to have ST elevations in inferior leads as well as an elevated serum Troponin I of 8.29 ng/ml (normal: <0.06 ng/ml). Urgent cardiac catheterization revealed total occlusion of the right coronary artery without other coronary disease or collaterals. Following a failed attempt at thrombus extraction, a 3.0 × 38 mm bioabsorbable drug-eluting stent was placed. Echocardiography then revealed large mobile aortic valve vegetations with the largest measuring 1.4 × 1.7 cm, severe tricuspid regurgitation with a 1.1 × 0.5 cm mobile vegetation on the anterior leaflet along with a patent foramen ovale with right-to-left shunting. Blood cultures identified in 4 of 4 vials. The patient underwent urgent replacement of tricuspid and aortic valves as well as 6 weeks of IV antibiotics followed by chronic antibiotic suppression.
冠状动脉栓塞事件导致的急性心肌梗死可作为感染性心内膜炎的并发症出现，发生率高达2.9%，且常为首发症状。一名35岁女性因典型胸痛4小时就诊，检查发现下壁导联ST段抬高，血清肌钙蛋白I升高至8.29 ng/ml（正常：<0.06 ng/ml）。紧急心脏导管检查显示右冠状动脉完全闭塞，无其他冠状动脉疾病或侧支循环。在血栓抽吸尝试失败后，植入了一枚3.0×38 mm的生物可吸收药物洗脱支架。随后的超声心动图显示主动脉瓣有大量活动的赘生物，最大者为1.4×1.7 cm，三尖瓣重度反流，前叶有一个1.1×0.5 cm的活动赘生物，同时存在卵圆孔未闭伴右向左分流。4瓶血培养均阳性。患者接受了三尖瓣和主动脉瓣的紧急置换以及6周的静脉抗生素治疗，随后进行长期抗生素抑制治疗。
