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Acute Myocardial Infarction in Rats
Published on: February 16, 2011
Infective endocarditis associated with acute myocardial infarction caused by septic emboli
Iwao Okai1, Kenji Inoue1, Naotaka Yamaguchi2
1Department of Cardiology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima-ku, Tokyo 177-8521, Japan.
Abstract:
A 53-year-old Japanese man presented with severe chest pain. He had suffered from persistent fever, muscle pain, arthralgia, and dyspnea on exertion (New York Heart Association class I) for two and half months prior to admission. He had been treated with several antibiotics for two months and prednisolone for almost one month prior to admission. On the day of admission, he had suffered from chest pain at rest, and had come to our hospital. Electrocardiography showed a normal sinus rhythm with significant ST segment elevation in leads V3-6 and abnormal Q waves in leads V4-6. Transthoracic echocardiography demonstrated left ventricular ejection fraction of 52% with severe mitral regurgitation and an 18-mm vegetation on the anterior mitral valve leaflet. Multiple blood cultures identified Streptococcus sanguis. The diagnosis was acute myocardial infarction and mitral regurgitation associated with infective endocarditis (IE). The incidence of acute coronary syndrome caused by IE is quite low in patients with native valves. After a 6-week course of antibiotics, mitral valve replacement and partial cardiomyotomy were performed. Two years after the surgery, follow-up echocardiography showed almost normal left ventricle function and no mitral regurgitation, and the patient has been living an active life without any complications.
Insights
Infective endocarditis (IE) can cause acute myocardial infarction and mitral regurgitation, even in native valves. Prompt treatment with antibiotics and surgery led to a full recovery for this patient.
Area of Science:
- Cardiology
- Infectious Diseases
- Cardiac Surgery
Background:
- Infective endocarditis (IE) is a serious infection affecting heart valves.
- Acute coronary syndrome (ACS) as a manifestation of IE on native valves is rare.
- This case highlights a complex presentation of IE.
Purpose of the Study:
- To report a rare case of acute myocardial infarction and severe mitral regurgitation caused by infective endocarditis.
- To discuss the diagnostic and therapeutic challenges in such cases.
- To emphasize the importance of considering IE in patients with ACS and valvular abnormalities.
Main Methods:
- Clinical presentation: 53-year-old male with chest pain, fever, arthralgia, and dyspnea.
- Diagnostic workup: Electrocardiography (ECG), Transthoracic Echocardiography (TTE), blood cultures.
- Treatment: Antibiotics, mitral valve replacement, and partial cardiomyotomy.
Main Results:
- Diagnosis of acute myocardial infarction and severe mitral regurgitation secondary to infective endocarditis caused by Streptococcus sanguis.
- Successful treatment with a 6-week antibiotic course followed by valve surgery.
- Excellent long-term outcome with normal cardiac function and no complications at 2-year follow-up.
Conclusions:
- Infective endocarditis can present as acute coronary syndrome with severe mitral regurgitation, even in patients with native valves.
- Multidisciplinary management involving cardiology, infectious diseases, and cardiac surgery is crucial.
- Early diagnosis and appropriate intervention lead to favorable long-term outcomes in complex IE cases.
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