Shatla Islam M, Banno Fady, Ejaz Ain, Lopez Candales Angel
Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, USA.
Internal Medicine, Ascension Genesys Hospital, Grand Blanc, USA.
Cureus. 2022 Mar 1;14(3):e22732. doi: 10.7759/cureus.22732. eCollection 2022 Mar.
We report a case of ST-elevation myocardial infarction (STEMI) due to septic emboli secondary to endocarditis in a 32-year-old male patient with a past medical history of infectious endocarditis requiring mechanical aortic, mitral and tricuspid valve replacement presented with sharp chest pain and shortness of breath. Electrocardiogram demonstrated an acute inferior STEMI. Coronary angiography revealed occlusion of the terminal left anterior descending (LAD) artery associated with a large apical wrap-around segment exhibiting TIMI 0 flow. Primary angioplasty was not performed given the distal location of the embolus. Clinical suspicion for septic or thrombotic coronary artery embolism was high given the patient's history of mechanical valve prosthesis and in the setting of sub-therapeutic INR. Transesophageal echocardiography revealed a new mobile echodensity on the mitral prosthesis consistent with vegetation. was isolated from blood cultures, confirming the diagnosis of endocarditis. is a rare cause of prosthetic valve endocarditis and should remain in the differential of septic coronary artery embolism among patients with features of infectious endocarditis.
我们报告一例32岁男性患者,既往有感染性心内膜炎病史,曾接受机械主动脉瓣、二尖瓣和三尖瓣置换术,因心内膜炎继发脓毒性栓子导致ST段抬高型心肌梗死(STEMI),表现为剧烈胸痛和呼吸急促。心电图显示急性下壁STEMI。冠状动脉造影显示左前降支(LAD)末端闭塞,伴有一个大的心尖环绕节段,TIMI血流0级。鉴于栓子位于远端,未进行直接血管成形术。考虑到患者有机械瓣膜假体病史且国际标准化比值(INR)未达标,临床上高度怀疑为脓毒性或血栓性冠状动脉栓塞。经食管超声心动图显示二尖瓣假体上有一个新的可移动回声密度,符合赘生物表现。血培养分离出[具体病原体未给出],确诊为心内膜炎。[具体病原体未给出]是人工瓣膜心内膜炎的罕见病因,在有感染性心内膜炎特征的患者中,应始终作为脓毒性冠状动脉栓塞的鉴别诊断之一。