Ahmed Islam Abdelmoneim, Asiri Abdullah Ali, Attia Mohamed, Alshehri Saleh
Department of Cardiology, PKBSCC, Armed Forces Hospital Southern Region, Khamis Mushait 61961, KSA.
Department of Cardiology, Al-Azhar University, Madinat Nasr, Cairo 11371, Egypt.
Eur Heart J Case Rep. 2023 Jan 19;7(1):ytad036. doi: 10.1093/ehjcr/ytad036. eCollection 2023 Jan.
Embolic myocardial infarction is an uncommon but increasingly recognized complication of infective endocarditis (IE). Although the incidence is low and ranges from 1% to 10%, the mortality rate is high (64%). The characteristics of septic embolism on presentation are nonspecific and usually are unrecognized by clinicians. This case report aims to build a high index of suspicion among clinicians for IE presenting with the complication of embolic myocardial infarction especially in patients with indwelling venous catheters.
A 62-year-old woman with end-stage renal disease on haemodialysis presented with shortness of breath and desaturation. Her history was significant for end-stage renal disease managed with regular haemodialysis by a right-sided double-lumen tunnelled catheter. An initial diagnosis was made of pulmonary embolism, and management with intravenous heparin was initiated. She subsequently developed inferolateral ST-elevation myocardial infarction, and treatment with percutaneous coronary intervention to the posterior descending artery failed. Then, the patient developed complete heart block, aortic valve vegetation, acute severe aortic regurgitation, and shock.
Acute coronary syndrome is usually an early and uncommon complication of IE and the risk of embolism decreases after antibiotic therapy is initiated. Due to the low incidence of coronary events in IE, only case reports have been published. Most patients with septic pulmonary embolism have a presentation similar to that for pneumonia. The diagnosis is therefore often delayed, which consequently influences prognosis. Our case report presents an example of IE-related multiple systemic embolization with poor patient outcome due to delayed diagnosis.
栓塞性心肌梗死是感染性心内膜炎（IE）一种罕见但日益被认识到的并发症。尽管其发病率较低，在1%至10%之间，但死亡率很高（64%）。脓毒性栓塞的临床表现特征不具特异性，临床医生通常难以识别。本病例报告旨在提高临床医生对伴有栓塞性心肌梗死并发症的IE的高度怀疑指数，特别是在有留置静脉导管的患者中。
一名62岁接受血液透析的终末期肾病女性患者，出现呼吸急促和血氧饱和度下降。她有通过右侧双腔隧道导管进行定期血液透析治疗终末期肾病的病史。初步诊断为肺栓塞，并开始静脉注射肝素治疗。随后她发生下壁心肌梗死，对后降支进行经皮冠状动脉介入治疗失败。接着，患者出现完全性心脏传导阻滞、主动脉瓣赘生物、急性严重主动脉瓣反流和休克。
急性冠状动脉综合征通常是IE早期且罕见的并发症，开始抗生素治疗后栓塞风险降低。由于IE中冠状动脉事件的发生率较低，仅有病例报告发表。大多数脓毒性肺栓塞患者的表现与肺炎相似。因此诊断往往延迟，从而影响预后。我们的病例报告展示了一例IE相关的多系统栓塞，因诊断延迟导致患者预后不良。
