Acute coronary syndrome complicating infective endocarditis: A case report with an etiological review
Soumia Boulouiz1,2,3, Amine Bouchlarhem1,2,3, Saidia Amaqdouf1,2,3
1Faculty of Medicine and Pharmacy, Mohammed I University, Oujda, Morocco.
Insights
Acute coronary syndrome (ACS) is a rare but deadly complication of infective endocarditis. Prompt diagnosis and multidisciplinary management are crucial for favorable outcomes in these high-risk patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Acute coronary syndrome (ACS) is an uncommon complication of infective endocarditis (IE).
- IE is associated with high mortality, necessitating prompt and appropriate management.
- Early recognition of IE in ACS patients without traditional cardiovascular risk factors is critical.
Observation:
- A 52-year-old patient presented with high-risk non-ST-segment elevation ACS.
- Coronary angiography was negative, but echocardiography revealed a mobile aortic valve image suggestive of IE.
- The patient underwent aortic valve replacement due to vegetation size and embolic complications.
Findings:
- ACS in IE can arise from embolic events, coronary artery compression by mycotic aneurysms, or vegetation obstruction of coronary ostia.
- Management requires a personalized, multidisciplinary approach involving an endocarditis team.
- Surgical intervention, such as aortic valve replacement, may be necessary for severe cases.
Implications:
- Infective endocarditis should be suspected in ACS patients presenting with fever and elevated inflammatory markers, even without typical cardiovascular risk factors.
- Early and accurate diagnosis through thorough clinical evaluation and investigations is vital.
- Timely and tailored therapeutic strategies are essential to improve patient outcomes in this rare but severe condition.
Introduction:
Acute coronary syndrome (ACS) is an uncommon complication associated with high mortality in patients with endocarditis. It requires prompt and appropriate management to cure the patient.
Cases Presentation:
We report the case of a 52-year-old patient, initially admitted for an acute non-ST-segment elevation coronary syndrome at very high ischemic risk, in whom coronary exploration was negative, and whose echocardiography showed a mobile image on the aortic valve, suggesting infective endocarditis. The patient benefited from an aortic valve replacement because of the size and the embolic complications he presented, with a favorable evolution.
Discussion:
Acute coronary syndrome during infective endocarditis is a rare complication with a high mortality rate. Several mechanisms are possible: the embolic mechanism, coronary extraluminal compression due to coronary mycotic aneurysm and obstruction of the coronary ostium by a large vegetation. The management remains multidisciplinary and personalized according to the phenotype of the patient, with the need to have the endocarditis team to be able to take the best therapeutic choice.
Conclusion:
Infective endocarditis must be evoked in any patient without usual cardiovascular risk factors who presents with an ACS that is accompanied by fever and elevated inflammatory markers, and a thorough clinical examination as well as the performance of additional tests.
Related Concept Videos
01:25Endocarditis I: Introduction
01:25Endocarditis II: Clinical Features of Infective Endocarditis
01:29Endocarditis IV: Nursing Management
01:18Endocarditis III: Medical Management
01:30Acute Coronary Syndrome I: Introduction
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations