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Acute coronary embolism complicating aortic valve endocarditis treated with streptokinase and aspirin. A case report
D L Connolly1, P S Dardas, J J Crowley
1Department of Cardiology, Papworth Hospital, Cambridge, United Kingdom.
Insights
Bacterial endocarditis can cause chest pain mimicking heart attacks due to coronary artery embolism. Standard clot-busting treatments for myocardial infarction may worsen bleeding in these cases.
Area of Science:
- Cardiology
- Infectious Diseases
- Vascular Medicine
Background:
- Bacterial endocarditis can lead to serious cardiac complications.
- Coronary artery embolism is a rare but critical presentation of endocarditis.
- Distinguishing embolic myocardial infarction from atherosclerotic coronary artery disease is crucial.
Observation:
- A case of aortic valve endocarditis presenting with acute chest pain due to coronary embolization is reported.
- The patient received standard thrombolytic therapy (streptokinase) and aspirin.
- This treatment resulted in myocardial infarction and gastrointestinal bleeding.
Findings:
- Coronary embolization from infective endocarditis can mimic acute myocardial infarction.
- Standard thrombolysis regimens may be contraindicated in myocardial infarction caused by endocarditis-related embolism.
- Early consideration of endocarditis is vital in patients with acute chest pain and suspected myocardial infarction.
Implications:
- Infective endocarditis must be considered in the differential diagnosis of acute chest pain.
- Physicians should exercise caution when administering thrombolytic therapy in patients with suspected endocarditis-related coronary embolism.
- Alternative treatment strategies may be necessary to avoid complications such as major bleeding.
Abstract:
Bacterial endocarditis may present with acute chest pain due to coronary embolization and mimics acute myocardial infarction secondary to coronary atherosclerosis. We present the first case report of coronary embolization secondary to aortic valve endocarditis treated with standard doses of streptokinase and aspirin. The patient survived but sustained a large myocardial infarction and a major gastrointestinal bleed. Infective endocarditis should be considered in all patients presenting with acute chest pain. When myocardial infarction is due to coronary embolism from endocarditic valves standard thrombolysis regimes should be avoided.