"Snake" shaped vegetation in right coronary artery.

Area of Science:

• Cardiology
• Infectious Diseases
• Vascular Medicine

Background:

• Infective endocarditis, an infection of the heart valves, is an uncommon cause of coronary artery embolism.
• Coronary embolism can precipitate myocardial infarction (MI), presenting a diagnostic and therapeutic challenge distinct from typical MI.
• Septic patients with MI require consideration of embolic causes, necessitating specific diagnostic approaches.

Observation:

• A 45-year-old male presented with vision loss and fevers, diagnosed with non-ST segment elevation myocardial infarction.
• Persistent bacteremia and systemic emboli were noted, with investigations revealing mitral valve vegetation.
• Cardiac catheterization identified a unique "snake"-shaped embolic vegetation within the right coronary artery.

Findings:

• The patient's condition was attributed to coronary embolism secondary to infective endocarditis.
• Management involved surgical intervention for the mitral valve vegetation and a course of antibiotics.
• The case highlights the importance of considering coronary embolism in septic patients with MI.

Implications:

• Early diagnosis of embolic MI in septic patients is critical for appropriate management, avoiding potentially harmful treatments like thrombolytics.
• Transesophageal echocardiography and cardiac catheterization are valuable tools for diagnosing and guiding treatment.
• This case underscores the need to include infective endocarditis as a differential diagnosis in myocardial infarction patients with signs of sepsis.