Bouchlarhem Amine, Amaqdouf Saidia, Noha El Ouafi, Bazid Zakaria
Faculty of Medicine and Pharmacy, Mohammed I University, Oujda, Morocco.
Department of Cardiology, Mohammed VI University, Hospital Mohammed I University, Oujda, Morocco.
Ann Med Surg (Lond). 2022 Sep 22;82:104737. doi: 10.1016/j.amsu.2022.104737. eCollection 2022 Oct.
Acute coronary syndrome (ACS) is an uncommon complication associated with high mortality in patients with endocarditis. It requires prompt and appropriate management to cure the patient.
We report the case of a 52-year-old patient, initially admitted for an acute non-ST-segment elevation coronary syndrome at very high ischemic risk, in whom coronary exploration was negative, and whose echocardiography showed a mobile image on the aortic valve, suggesting infective endocarditis. The patient benefited from an aortic valve replacement because of the size and the embolic complications he presented, with a favorable evolution.
Acute coronary syndrome during infective endocarditis is a rare complication with a high mortality rate. Several mechanisms are possible: the embolic mechanism, coronary extraluminal compression due to coronary mycotic aneurysm and obstruction of the coronary ostium by a large vegetation. The management remains multidisciplinary and personalized according to the phenotype of the patient, with the need to have the endocarditis team to be able to take the best therapeutic choice.
Infective endocarditis must be evoked in any patient without usual cardiovascular risk factors who presents with an ACS that is accompanied by fever and elevated inflammatory markers, and a thorough clinical examination as well as the performance of additional tests.
急性冠状动脉综合征（ACS）是心内膜炎患者中一种罕见但死亡率高的并发症。需要及时且恰当的治疗来治愈患者。
我们报告一例52岁患者，最初因急性非ST段抬高型冠状动脉综合征入院，缺血风险极高，冠状动脉检查结果为阴性，超声心动图显示主动脉瓣有活动影像，提示感染性心内膜炎。由于其病变大小及出现的栓塞并发症，该患者接受了主动脉瓣置换术，病情进展良好。
感染性心内膜炎期间的急性冠状动脉综合征是一种罕见且死亡率高的并发症。可能有多种机制：栓塞机制、冠状动脉霉菌性动脉瘤导致的冠状动脉腔外压迫以及大的赘生物阻塞冠状动脉开口。治疗仍需多学科且根据患者表型个体化，需要心内膜炎治疗团队做出最佳治疗选择。
对于任何无常见心血管危险因素、出现伴有发热和炎症标志物升高的急性冠状动脉综合征的患者，必须考虑感染性心内膜炎，并进行全面的临床检查及额外检查。
