Infective Endocarditis With Coronary Artery Embolization and Multisystem Involvement in a Patient With a History of...

Infective endocarditis (IE) is a rare cause of myocardial infarction (MI). In contrast to other embolic phenomena associated with IE, the incidence of coronary embolism is <1 % with a mortality rate of >65 %. Common risk factors of IE include intravenous drug use (IVDU), hemodialysis and the use of cardiac devices. We present a unique case of multiple coronary artery involvement on 2 separate occasions highlighting the need for increased awareness among healthcare professionals.

A 38-year-old female with history of IVDU, hepatitis B and C presented with acute chest pain and was found to have NSTEMI and active aortic valve vegetation. Left heart catheterization (LHC) revealed an occlusion of the right coronary artery (RCA), which was treated with stent placement. However, on experiencing ventricular fibrillation on hospital day 2, a repeat cardiac catheterization revealed a re-occlusion of RCA proximal to the stent as well as occlusion of the first obtuse marginal artery (OM1). Subsequent investigations also revealed multiple intraparenchymal hemorrhages and probable renal infarcts. The involvement of multiple systems, as well as the occlusion of multiple coronary arteries on separate occasions distinguishes this case from previously reported cases.

Timely intervention is critical in the management of MI due to septic embolism. A high index of suspicion and immediate action can be lifesaving. Early diagnostic imaging and percutaneous or surgical interventions can improve patient outcomes. Greater awareness of multisystem and multi-coronary artery embolic phenomena is needed.