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Chest pain with ST segment elevation in a patient with prosthetic aortic valve infective endocarditis: a case report

Vishal Luther1, Refai Showkathali, Reto Gamma

  • 1Department of Medicine, Whittington Hospital NHS Trust, Magdala Avenue, London, N19 5NF, UK. vishal_luther@yahoo.co.uk.

Journal of Medical Case Reports
|August 26, 2011
PubMed

Insights

Acute myocardial infarction can stem from infective endocarditis complications, not just plaque rupture. Standard treatments like thrombolysis or PCI may pose risks in these rare cases, necessitating specialized cardiac center referral.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Medical Case Reports

Background:

  • Acute ST-segment elevation myocardial infarction (STEMI) is typically caused by atherosclerotic plaque rupture and managed with percutaneous coronary intervention (PCI) or thrombolysis.
  • Infective endocarditis, an infection of heart valves, can lead to serious complications, including systemic embolization.

Purpose of the Study:

  • To report a rare case of acute myocardial infarction (MI) caused by coronary embolization of valvular vegetation from infective endocarditis.
  • To highlight the potential dangers of standard MI treatments in this specific clinical scenario and emphasize the need for alternative management strategies.

Main Methods:

  • A case report of a 73-year-old male patient with a history of aortic valve replacement who developed infective endocarditis of his native mitral valve.
  • Clinical presentation included vegetation migration, subsequent development of anterior STEMI, and absence of traditional ischemic heart disease risk factors.
  • Management decisions were made in the context of suspected coronary embolization from the valvular vegetation, with standard treatments withheld.

Main Results:

  • The patient experienced acute MI attributed to coronary embolization of valvular vegetation.
  • Standard MI treatments (thrombolysis, PCI) were not performed due to the suspected embolic source and associated risks.
  • The patient's condition rapidly deteriorated, leading to an unfavorable outcome despite plans for urgent surgical intervention.

Conclusions:

  • Acute myocardial infarction can arise from causes other than atherosclerotic plaque rupture, such as septic vegetation embolization in infective endocarditis.
  • Standard MI treatments carry significant risks in cases of septic embolization, including intracranial hemorrhage, mycotic aneurysm formation, and stent infections.
  • Referral to specialist cardiac centers is crucial for managing these complex cases due to the lack of defined treatment protocols and potential treatment-related complications.
Abstract

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