Department of Infectious Disease, Eastern Virginia Medical School, Norfolk, VA, USA.
Department of Infectious Disease, Sentara Norfolk General Hospital, Norfolk, VA, USA.
J Int Med Res. 2022 Jul;50(7):3000605221112019. doi: 10.1177/03000605221112019.
A 69-year-old woman was airlifted to the emergency department after awakening with angina, diaphoresis, and shortness of breath. She was found to have ST-elevation myocardial infarction with 100% occlusion of her left anterior descending artery, and aspiration thrombectomy was performed. Blood cultures confirmed bacteremia. Our team used a clinical tool to determine whether transesophageal echocardiography was warranted to investigate for infective endocarditis. The patient's transesophageal echocardiogram showed a large mobile vegetation on her mitral valve. Given the presence of infective endocarditis in the absence of known coronary artery disease, we determined that the patient had likely developed acute coronary syndrome from a septic embolus originating from her mitral valve vegetation. Further investigation for the source of the bacteremia revealed a perforation 20 cm from the anal verge at the rectosigmoid junction. After perforation repair, the patient became hypoxic and tachycardic with diffuse abdominal pain, guarding, rebound tenderness, and loss of pulse. Exploratory laparotomy revealed air in the mesentery consistent with extraperitoneal perforation of the rectum, and an end-colostomy was performed. Unfortunately, the patient subsequently died.
一位 69 岁女性在出现心绞痛、出汗和呼吸急促后被空运到急诊部。她被诊断为 ST 段抬高型心肌梗死，伴有左前降支 100%闭塞，并进行了抽吸血栓切除术。血培养证实为菌血症。我们的团队使用一种临床工具来确定是否需要行经食管超声心动图检查以调查是否存在感染性心内膜炎。患者的经食管超声心动图显示二尖瓣上有一个大的活动性赘生物。鉴于存在感染性心内膜炎而无已知的冠状动脉疾病，我们确定该患者可能是由于二尖瓣赘生物的脓毒性栓子引起了急性冠状动脉综合征。进一步调查菌血症的来源发现，在直肠乙状结肠交界处距肛门 20 厘米处有穿孔。穿孔修复后，患者出现缺氧、心动过速、弥漫性腹痛、压痛、反跳痛和脉搏消失。剖腹探查显示肠系膜中有空气，提示直肠腹膜外穿孔，行结肠造口术。不幸的是，患者随后死亡。
