Ferreira Carvalho Mariana, Gonçalves Carolina, Saldanha Santos Beatriz, Morais João
Cardiology Division, Unidade Local de Saúde da Região de Leiria, Rua das Olhalvas, Pousos, 2410-197 Leiria, Portugal.
Cardiology Division, Unidade Local de Saúde de Coimbra, Praceta Professor Mota Pinto, Celas, 3004-561 Coimbra, Portugal.
Eur Heart J Case Rep. 2025 Jan 29;9(2):ytaf037. doi: 10.1093/ehjcr/ytaf037. eCollection 2025 Feb.
Acute ST-elevation myocardial infarction (STEMI) complicated by infective endocarditis (IE) presents a unique challenge in clinical management, especially when associated with septic embolism leading to coronary artery occlusion.
The current clinical report describes the case of a 72-year-old male with a history of arterial hypertension, dyslipidaemia, and severe obstructive sleep apnea. The patient presented with anterior STEMI due to an embolic occlusion in the left anterior descending (LAD) artery, secondary to IE. Coronary angiography revealed embolic occlusion at the LAD origin, and balloon angioplasty without stent placement was performed, considering the embolic and infectious nature of the occlusion. Despite targeted interventions, including broad-spectrum antibiotics and support for cardiogenic shock, the patient's condition deteriorated, leading to cardiac arrest and subsequent death on the fourth day of hospitalization.
This case emphasizes the critical need for adapting STEMI management in the presence of IE. It highlights the importance of considering IE in STEMI differential diagnosis and adjusting intervention strategies accordingly.
急性ST段抬高型心肌梗死（STEMI）合并感染性心内膜炎（IE）在临床管理中是一项独特的挑战，尤其是当合并导致冠状动脉闭塞的脓毒性栓塞时。
本临床报告描述了一名72岁男性患者，有动脉高血压、血脂异常和严重阻塞性睡眠呼吸暂停病史。该患者因IE继发左前降支（LAD）动脉栓塞性闭塞而出现前壁STEMI。冠状动脉造影显示LAD起始处栓塞性闭塞，考虑到闭塞的栓塞性和感染性性质，进行了未置入支架的球囊血管成形术。尽管采取了包括广谱抗生素和心源性休克支持在内的针对性干预措施，但患者病情仍恶化，导致心脏骤停，并于住院第四天死亡。
本病例强调了在存在IE的情况下调整STEMI管理的迫切需求。它突出了在STEMI鉴别诊断中考虑IE并相应调整干预策略的重要性。
