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Sudden death due to left coronary artery occlusion in infective endocarditis
1Southwestern Institute of Forensic Sciences, University of Texas Health Science Center, Dallas.
Insights
A sudden death case highlights rare infective endocarditis complications. Streptococcus viridans caused aortic valve vegetations obstructing coronary arteries, leading to myocardial infarction and abscesses.
Area of Science:
- Cardiology
- Infectious Diseases
- Pathology
Background:
- A 44-year-old male with chronic alcoholism and homozygous hemoglobin C disease presented with abdominal pain.
- Sudden death occurred shortly after hospital admission.
Observation:
- Autopsy revealed aortic valve vegetations, particularly on the left coronary cusp.
- Anomalous origin of coronary arteries from the left sinus of Valsalva was noted.
- Vegetation extended into the left main-stem coronary artery, causing obstruction.
Findings:
- Evidence of prior embolization to the right coronary artery with mycotic aneurysm and myocardial infarction.
- Additional findings included a cerebral artery mycotic aneurysm and metastatic abscesses in the myocardium and spleen.
- The causative organism was identified as Streptococcus viridans, with no underlying chronic aortic valve pathology.
Implications:
- This case presents unusual and unique findings in infective endocarditis.
- Highlights the potential for severe complications, including coronary artery obstruction and systemic embolization.
- Underscores the importance of considering infective endocarditis in patients with relevant risk factors and atypical presentations.
Abstract:
A 44-year-old man died suddenly, shortly after admission to the hospital with complaints of abdominal pain. Medical history was significant for chronic alcoholism and homozygous hemoglobin C disease. Autopsy revealed vegetations on the aortic valve, especially on the left coronary cusp. There was anomalous origin of the coronary arteries from the left sinus of Valsalva. The large vegetation on the left coronary cusp had extended into the left main-stem coronary artery and obstructed it. There was evidence of prior embolization to the right coronary artery with mycotic aneurysm formation and myocardial infarction. Other lesions included a cerebral artery mycotic aneurysm and metastatic abscesses within the myocardium and spleen. Although the aortic valve was free of underlying chronic pathology, the causative organism was Streptococcus viridans. This case illustrates several unusual, and, in some instances, unique findings in infective endocarditis.