Septic coronary embolism in a deceptive case of presumed isolated tricuspid valve endocarditis.

A 46-year-old female presented with native tricuspid valve endocarditis complicated by a stroke with a hemorrhagic component. There was no evidence of intracardiac shunt nor left-sided valve involvement. Delayed surgery was planned to allow neurologic recovery, however, the patient developed an ST-elevation myocardial infarction and cardiac arrest from an occluded right posterior ventricular branch of the right coronary artery from a septic embolism. Repeat imaging demonstrated new aortic valve vegetation involving the right coronary cusp. This case highlights a unique sequence of events in a patient initially presenting with presumed isolated tricuspid valve vegetation.