Prashar Abhisheik, Chen Daniel, Youssef George, Ramsay David
Department of Cardiology, St George Hospital, Sydney, NSW 2217, Australia.
Eur Heart J Case Rep. 2020 Aug 25;4(5):1-4. doi: 10.1093/ehjcr/ytaa193. eCollection 2020 Oct.
Coronary artery emboli can occur from a number of rare causes such as arterial thrombo-embolus or septic embolus. This diagnosis generally requires multi-modal imaging including echocardiography, computed tomography, or invasive coronary angiography. Septic coronary emboli is an extremely rare consequence of infective endocarditis (IE), having been reported in <1% of all cases.
A 54-year-old previously healthy Tibetan monk presented feeling generally unwell and lethargic. Electrocardiogram demonstrated sinus rhythm, third-degree atrioventricular block with a left bundle branch escape. Initial transthoracic and transoesophageal echocardiography demonstrated vegetations on the aortic and tricuspid valve as well as intra-myocardial abscess. Coronary angiography revealed septic embolus involving the septal perforator coronary artery. He underwent surgical replacement of the infected valves and debridement and repair of a ventricular septal defect.
Infective endocarditis can predispose to a range of cardiac pathology. This case demonstrates that patients can present with cardiac conduction disease from a septic embolus involving a coronary artery as a complication of IE.
冠状动脉栓塞可由多种罕见原因引起，如动脉血栓栓塞或脓毒性栓子。该诊断通常需要多模态成像，包括超声心动图、计算机断层扫描或有创冠状动脉造影。脓毒性冠状动脉栓塞是感染性心内膜炎（IE）极其罕见的后果，在所有病例中的报告发生率<1%。
一名54岁既往健康的藏族僧侣，自觉全身不适、乏力。心电图显示窦性心律、三度房室传导阻滞伴左束支逸搏。最初的经胸和经食管超声心动图显示主动脉瓣和三尖瓣有赘生物以及心肌内脓肿。冠状动脉造影显示脓毒性栓子累及间隔支冠状动脉。他接受了感染瓣膜的手术置换以及室间隔缺损的清创和修复。
感染性心内膜炎可引发一系列心脏病变。该病例表明，患者可因IE并发症——累及冠状动脉的脓毒性栓子而出现心脏传导疾病。
