Case ReportManaging embolic myocardial infarction in infective endocarditis: current options
Introduction
Coronary embolization in the setting of infective endocarditis is a potential complication but has rarely been described as a cause of transmural myocardial infarction.1, 2 There are obvious concerns in deciding how to treat coronary emboli in the setting of endocarditis, including the usage of thrombolytics or anticoagulation, yet this issue is seldom addressed in the literature. We present two patients with acute myocardial infarction (MI) in the setting of infective endocarditis and outline principles of management of this rare complication.
Section snippets
Patient 1
A 16-year-old female with no history of intravenous drug use was transferred to our institution for further management of endocarditis. She had presented at the referring institution with acute onset of left-sided chest pain. The patient's temperature here was 37.8 °C. She was hemodynamically stable with grade I–II systolic murmur at the mitral area. She was diagnosed as having antero-apical wall MI. Emergent cardiac catheterization revealed total occlusion of mid-distal LAD but attempts
Discussion
Virchow first described coronary arterial occlusion complicating acute bacterial endocarditis in 1856. It was thought to be an invariably fatal complication until Massafia diagnosed it in a living patient in 1948. Garvey and Neu described 107 cases of native valve endocarditis of which myocardial involvement was noted in 13 (coronary emboli in 8, myocardial abscesses in 5).2
Infective endocarditis due to Staphylococcus aureus, Candida, HACEK organisms and Abiotrophia are at higher risk for
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