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Endocarditis Associated With Coronary Cameral Fistula Presenting With Intracranial Hemorrhage

Waqas Hanif1, Martin Sayegh1, Muhammad Umer Farooq1

  • 1Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA.

JACC. Case Reports
|October 3, 2024
PubMed

Insights

Coronary cameral fistulas, rare heart connections, can lead to infective endocarditis. This case highlights a unique presentation of endocarditis on a papillary muscle, linked to a coronary cameral fistula and causing a brain aneurysm.

Area of Science:

  • Cardiology
  • Neurology
  • Infectious Diseases

Background:

  • Coronary cameral fistulas are uncommon abnormal connections between the coronary arteries and heart chambers.
  • While often asymptomatic, they can cause chamber volume overload and turbulent diastolic flow, increasing endocarditis risk.

Observation:

  • This report details a unique case where infective endocarditis manifested as an intracerebral hemorrhage with a mycotic aneurysm.
  • The endocarditis was nonvalvular, located on the mitral anterolateral papillary muscle.

Findings:

  • A large coronary cameral fistula was identified at the ventricular entrance site of the affected papillary muscle.
  • The patient's presentation of stroke secondary to endocarditis was directly linked to the underlying fistula.

Implications:

  • This case underscores the potential for coronary cameral fistulas to be a nidus for infective endocarditis, even in nonvalvular locations.
  • Early recognition and management of coronary cameral fistulas are crucial to prevent severe complications like mycotic aneurysms and intracerebral hemorrhage.

Keywords:
antibiotics prophylaxiscoronary cameral fistulamycotic aneurysmnonvalvular endocarditis

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