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Thrombus or vegetation: A mystery causing ST elevation myocardial infarction with infective endocarditis of

Safi U Khan1, Ahmad N Lone1, Charumathi Raghu Subramanian1

  • 1Guthrie Clinic/Robert Packer Hospital, Sayre, PA, 18850.

Cardiovascular Revascularization Medicine : Including Molecular Interventions
|March 14, 2017
PubMed

Insights

Diagnosing ST-elevation myocardial infarction (STEMI) in patients with infective endocarditis (IE) and mechanical valves is complex. A conservative approach was successful in a case of STEMI during IE treatment, differentiating septic emboli from prosthesis thromboembolism.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Cardiac Surgery

Background:

  • Infective endocarditis (IE) with mechanical cardiac valve prosthesis presents diagnostic challenges, particularly when complicated by acute myocardial infarction (MI).
  • Differentiating between septic emboli and prosthesis-related thromboembolism is critical for appropriate management, especially with normal coronary vasculature and sub-therapeutic INR.

Observation:

  • A 56-year-old patient with a mechanical aortic valve developed ST-elevation MI during treatment for IE.
  • Cardiac catheterization revealed a subtle distal blockage in the Left Anterior Descending (LAD) artery, precluding percutaneous coronary intervention (PCI).

Findings:

  • The case highlights the diagnostic dilemma in distinguishing septic emboli from thromboembolism in the context of IE and mechanical valves.
  • A successful conservative management strategy was employed due to the unclear etiology and technical limitations for PCI.

Implications:

  • This case underscores the importance of a tailored, conservative approach in complex scenarios of MI secondary to IE with mechanical valves.
  • Further research may elucidate optimal diagnostic and therapeutic strategies for this rare but serious clinical presentation.
Keywords:
Prosthetic cardiac valvesSTEMI, infective endocarditisSeptic embolism

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