[Myocardial infarction in patients with infectious endocarditis]

Area of Science:

• Cardiology
• Infectious Diseases
• Pathophysiology

Background:

• Active infectious endocarditis presents a significant risk for developing myocardial infarction (MI).
• MI in this context is linked to a more severe clinical course and poorer outcomes for infectious endocarditis patients.

Purpose of the Study:

• To investigate the incidence, clinical presentation, diagnostic challenges, and underlying causes of myocardial infarction in patients with active infectious endocarditis.
• To elucidate the pathogenesis of MI in infectious endocarditis to improve diagnosis and therapy.

Main Methods:

• Retrospective analysis of 230 patients with active infectious endocarditis.
• Clinical data review, including MI presentation, electrocardiography (ECG), cardiac enzyme levels, and echocardiography.
• Assessment of potential etiological factors such as aortic valve vegetation, aortic insufficiency, and hemostatic disturbances.

Main Results:

• Myocardial infarction (MI) developed in 9% of patients.
• MI presented with pain in 43% and was painless in 57%; initial symptoms included arrhythmias, conduction disturbances, and left ventricular failure in 29%.
• Diagnosis was confirmed in all cases through repetitive ECGs and in 81% via enzyme elevation. Key causes included aortic valve vegetation (47%) and aortic insufficiency (62%), alongside hemostatic abnormalities.

Conclusions:

• Myocardial infarction is a critical complication of infectious endocarditis, significantly impacting prognosis.
• Diagnosis can be challenging due to atypical presentations, necessitating serial ECGs and enzyme monitoring.
• Understanding the multifactorial pathogenesis involving cardiac valve and hemodynamic factors, as well as hemostasis, is crucial for targeted interventions.