Case of Acute ST Segment Elevation Myocardial Infarction in Infective Endocarditis-Management with Intra Coronary...

Area of Science:

• Cardiology
• Infectious Diseases
• Vascular Medicine

Background:

• Infective endocarditis (IE) poses a significant risk for embolic complications, including acute coronary syndrome (ACS).
• Optimal management strategies for IE-related ACS may differ from those for atherosclerotic coronary artery disease.
• High mortality rates associated with IE underscore the need for effective treatment protocols.

Observation:

• A 56-year-old male with aortic valve endocarditis presented with acute ST-segment elevation myocardial infarction (STEMI) despite recent normal left heart catheterization.
• The myocardial infarction was attributed to a septic embolic event originating from sterile vegetations associated with endocarditis.
• The patient had already undergone 5 weeks of antibiotic therapy for the endocarditis.

Findings:

• The patient was treated with percutaneous coronary intervention, including balloon angioplasty and intracoronary stent placement.
• Successful re-vascularization led to immediate relief of chest pain and normalization of electrocardiogram findings.
• Short-term recovery was observed post-intervention.

Implications:

• This case demonstrates the efficacy of interventional cardiology techniques in managing acute coronary events secondary to infective endocarditis.
• It highlights the importance of considering embolic phenomena from IE in the differential diagnosis of ACS, even with seemingly normal coronary angiograms.
• Despite successful re-vascularization, the patient's multiple comorbidities necessitated intensive supportive care, including intubation and dialysis, indicating the complex interplay between IE, cardiovascular events, and overall patient health.