Native Valve Infective Endocarditis Presenting With a Non-ST-Segment Elevation Myocardial Infarction

Septic coronary embolism presenting with an acute coronary syndrome is a rare and unusual manifestation of infective endocarditis and remains challenging to identify in the acute setting.

A 36-year-old man presented with chest pain. A diagnosis of non-ST-segment elevation myocardial infarction was made, and coronary angiography revealed a filling defect in the left anterior descending artery and first diagonal branch, without evidence of coronary dissection or atherosclerosis. The patient subsequently developed recurrent fever. Blood cultures were positive for Streptococcus mutans, and transesophageal echocardiography confirmed vegetations on the aortic valve with aortic regurgitation. He was treated with intravenous antibiotics and had a favorable outcome.

Acute coronary syndrome is an uncommon but serious early complication of infective endocarditis, often associated with heart failure, cardiogenic shock, and high mortality. The lack of consensus regarding optimal management underscores the need for a multidisciplinary approach to individualized patient care.