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Native mitral valve streptococcal endocarditis presenting as myocardial infarction and diagnosed with multimodality

Joshua Wilcox1,2, Arshan Jimmy Dadrewalla3, Manil Subesinghe4,5

  • 1Guy's and St Thomas' Hospitals NHS Trust, London, UK.

BMJ Case Reports
|November 8, 2024
PubMed

Insights

A man with flu-like symptoms developed chest pain, revealing myocardial infarction and mitral valve endocarditis caused by Streptococcus gordonii. Multimodality imaging confirmed the diagnosis and embolic events.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Medical Imaging

Background:

  • Infective endocarditis is a serious infection of the heart valves.
  • Prompt diagnosis and treatment are crucial to prevent complications such as embolic events and myocardial infarction.
  • Multimodality imaging plays a vital role in diagnosing complex cardiovascular conditions.

Observation:

  • A 60-year-old male presented with chest pain and flu-like symptoms.
  • ECG and cardiac biomarkers indicated myocardial injury, with coronary angiography showing an obstructed artery.
  • Blood cultures identified Streptococcus gordonii, and echocardiography revealed a mitral valve lesion.

Findings:

  • The patient was diagnosed with embolic infarction secondary to native mitral valve infective endocarditis.
  • [18F]Flurodeoxyglucose Positron Emission Tomography CT, cardiac MRI, and brain MRI confirmed myocardial infarction, mitral valve infection, and cerebral embolic phenomena.
  • The case highlights Streptococcus gordonii as a causative agent in infective endocarditis leading to embolic complications.

Implications:

  • This case underscores the importance of a flexible, evolving diagnostic strategy when faced with complex clinical presentations.
  • Multidisciplinary collaboration, particularly within an endocarditis team, is essential for optimal patient management.
  • Advanced multimodality imaging techniques are invaluable for achieving diagnostic certainty in infective endocarditis and its sequelae.

Keywords:
Infectious diseasesInterventional cardiologyRadiology (diagnostics)Valvar diseases

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